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THE    CHILD 


ITS    CARE,    DIET,   AND   COMMON   ILLS 


BY 

E.  MATHER  SILL,  M.D. 

LECTURER  IN   DISEASES  OF   CHILDREN  AT  THE   NEW  YORK  POLYCLINIC  MEDICAL 

SCHOOL    AND    HOSPITAL.        ATTENDING    PHYSICIAN    AT    THE    GOOD 

SAMARITAN   DISPENSARY  AND    ASSISTANT    ATTENDING 

AT  THE  NEW   YORK.  POLYCLINIC  HOSPITAL 


NEW  YORK 

HENRY  HOLT  AND  COMPANY 

1913 


^A) 


^\^^^ 


Copyright,  1913, 

BY 

HENRY  HOLT  AND  COMPANY 


Published  May,  1913 


THE    QUINN    A    BODEN    CO.  PRESS 
RAHWAY,    N.   J. 


THE    YOUNG    MOTHERS 

IN  WHOSE  INTEREST  THESE   PAGES  WERE  WRITTEN 

I  INSCRIBE  THIS  LITTLE  VOLUME 


281751 


FOREWORD 

In  this  age  of  enlightenment  the  young  progressive 
mother  is  not  satisfied  to  follow  the  customs  and  dic- 
tation of  her  mother  or  grandmother.  She  wishes  to 
have  her  methods  formed  upon  the  latest  and  best 
medical  practice.  She  wishes  to  be  intelligent  in  case 
of  illness.  She  insists  upon  knowing  the  best  and 
most  scientific  ways  of  feeding,  airing,  clothing,  and 
giving  out-of-door  exercise.  She  also  insists  upon  a 
knowledge  of  what  to  do  in  emergencies  before  the 
arrival  of  the  doctor,  and,  in  a  general  way,  at  least, 
she  wishes  to  be  able  to  distinguish  between  the  differ- 
ent diseases  which  all  children  are  more  or  less  subject 
to  and  liable  to  contract. 

The  young  mother  of  to-day  wishes  to  know  what 
to  do  in  case  of  accident,  injury,  or  accidental  poison- 
ing; she  wishes  to  understand  when  it  is  necessary 
to  have  medical  advice;  in  a  word,  she  desires  to 
acquire  that  confidence  in  herself  which  shall  make 
her  mistress  of  such  situations  as  will  most  probably 
arise  in  the  bringing  up  of  her  children. 

To  help  the  young  mother  in  her  efforts  to  attain 
efficiency,  the  author  has  endeavored  to  answer  all 
questions  that  the  intelligent  young  mother  would 
wish  to  ask,  and  to  explain  the  problems  that  are  apt 
to  confront  her. 


vi  FOREWORD 

These  answers  and  explanations  are  the  outcome 
of  a  very  large  experience  in  the  treatment  of  infants 
and  young  children. 

The  author  wishes  to  express  his  thanks  to  Drs. 
Holt,  Kerley,  Koplik,  Chapin,  and  others,  for  valuable 
suggestions  from  their  works  on  diseases  of  infants 
and  children  and  to  his  publishers,  Messrs.  Henry 
Holt  and  Company,  for  many  courtesies  extended 
to  him. 


ILLUSTRATIONS 

PAGE 

The  Baby  Basket :        .  3 

Knitted  Abdominal  Band 5 

The  Baby  Crib 8 

Bassinet 9 

Bath  Thermometer .15 

Rubber  Tub 18 

Denton  Nightdress 19 

Union  Suit 20 

The  Healthy  Child  Fourteen  Months  of  Age     ...  27 

The  Exercise  Yard  or  Pen 32 

The  Glascock  Baby  Walker 34 

Nipple  Shield 38 

English  Breast-Pump 88 

Freeman  Pasteurizer 51 

Nursing-Bottle  and  Nipple 53 

Chapin  Dipper 56 

Pint  Graduate  Measure 57 

The  Deming  Milk  Modifier 64 

Knitted  Bag  for  Bottle 65 

In-a-Wink  Heater 65 

Way  to  Hold  the  Baby  when  Nursing  the  Bottle      .        .  66 

Way  to  Hold  the  Baby  when  Nursing  the  Breast     .        .  67 

Ice-Box  for  Traveling 72 

Breck  Feeder 81 

Syringe  for  Oil  Enema 95 

vii 


viii  ILLUSTRATIONS 

PAGE 

The  Birmingliam  Douche .  103 

Oil  Nebulizer 104 

Proper  Way  to  Examine  the  Throat 106 

Way  to  Apply  a  Compress  to  the  Throat          .        .        .  108 

Soft  Rubber  Ear  Syringe 113 

Holt  Croup  Kettle 116 

Hand-1-Hold   Babe    Mits    and    Method  of   Bandaging  in 

Eczema  of  the  Head  and  Face 128 

Schering's  Formalin  Fumigator    ......  181 

Formalin  Lamp  (Schering)    .......  182 


THE  CHILD 


"Madonnas  hallow  every  home; 
O'er  every  roof  where  babies  are 
Shines  high  and  pure  a  guiding  star; 
And  mother  hearts  do  always  hear 
Divinest  music  ringing  clear, 
And  peace  and  love,  good  will  on  earth, 
Are  born  with  every  baby's  birth." 

From  Songs  of  Motherhood  of 
Elizabeth  Johnson  Huckel. 


THE  BABY  BASKET,  AND  WHAT  IT  SHOULD 
CONTAIN 


The  Baby  Basket. 

A  baby  basket,  containing  all  the  toilet  articles 
which  will  be  needed,  is  most  essential,  and  should 
be  in  readiness,  supplied  as  follows: 

1.  One  good-sized  pincushion. 

2.  Three  packages  safety-pins,  assorted  sizes   (Nos.  1, 
21/2,  3). 

8 


4       V',.  ^  ;;'THE  CHILD 

'   3.  Box  tait^ujtn  I  powder. 
4.'  Cake  Castile  ^6£tp  "in"  soap-box. 

5.  Three  knit  wash-cloths. 

6.  Three  soft  bath  towels  and  three  baby  towels. 

7.  Infant  hair-brush  and  fine-tooth  comb. 

8.  One  tube  or  jar  of  white  vaseline. 

9.  Puff  and  puff-box  (absorbent  cotton  may  be  used  in 
place  of  puff). 

10.  Half-pound  absorbent  cotton. , 

11.  A  bath  thermometer. 

12.  A  yard  of  sterile  gauze  and  plenty  of  old  linen. 

13.  A  good-sized  bottle  of  saturated  solution  of  boracic 
acid  for  washing  the  eyes  and  mouth. 

14.  One  package  of  wooden  toothpicks. 

15.  An  eiderdown  blanket,  a  yard  and  a  half  long,  to 
wrap  the  baby  in. 

16.. A  small  pair  of  scissors. 

17. ;  Two   lap-pads  one-half  yard  square,  and  two  pads 
one  yjard  square  to  go  in  the  crib. 

18.  A  piece  of  bobbin  to  tie  cord  (supplied  by  obstetri- 
cian). 

19.  Bottle  of  sweet-oil. 


CLOTHING  NEEDED  FOR  THE  EXPECTED  BABY 
(FIRST  SIX  WEEKS) 

1.  Four  second-size  silk  and  wool  shirts. 

2.  One  yard  of  soft,  white,  Shaker  flannel  to  be  made 
into  belly-bands.  After  the  sixth  week,  knitted  abdominal 
bands  with  shoulder-straps  are  to  be  preferred. 

3.  Two  pair  of  Cashmere  hose. 

4.  Two  outing-flannel  skirts   (for  the  night). 

5.  Three  flannel  skirts   (for  the  day).  Jl 


THE  CHILD 

6.  Three  white  skirts    (nainsook). 

7.  One  eiderdown  wrapper. 

8.  Three  slips   (bishop  pattern). 


Knitted  Abdominal  Band. 

9.  Four  dozen  cotton  diapers  made  from  bird's-eye  cot- 
ton.    Two  sizes  will  be  necessary: 

1.  Three  pieces  twenty  inches. 

2.  Three  pieces  twenty-two  inches. 

And  the  diaper  should  be  made  20  x  40  and  22  x  44  inches 
respectively. 

10.  Three  plain  slips  to  be  used  for  night-dresses. 

11.  Two  Cashmere  sacques. 

12.  Two  Shaker  flannel  bath  aprons  to  be  used  by  the 
nurse  to  wrap  the  baby  in  after  the  bath. 


THE  GERTRUDE  OUTFIT  FOR  AN  INFANT 

A  long,  plain,  light-weight,  soft,  white,  flannel  slip  with- 
out sleeves,  and  seams  on  the  outside;  this  garment  is  worn 
next  to  the  skin  and  takes  the  place  of  a  shirt. 


6  THE  CHILD 

Three  long,  plain,  light-weight,  soft,  white,  flannel  slips 
with  sleeves,  and  seams  on  the  inside,  to  be  worn  over  the 
first  garment. 

Three  slips  made  like  the  first  garment  except  having 
sleeves,  to  be  used  as  night-dresses. 

Three  five-inch  soft,  white  flannel  binders  fifteen  inches  ' 
long. 

Twelve  simple  white  dresses  or  slips  of  nainsook  or 
muslin  made  after  the  bishop  pattern,  to  be  worn  over  the 
two  flannel  garments. 

Three  more  elaborate  dresses  of  the  same  material. 

Four  pair  of  white  merino  stockings. 

Six  pair  of  booties. 

One  dozen  double  white  cheesecloth  squares,  ten  inches 
square,  to  be  used  as  diapers  for  the  first  five  months. 

Three  dozen  eighteen-inch  squares  of  canton  flannel,  these 
being  worn  over  the  cheesecloth  diapers  as  absorbers. 

Two  .dozen  16  x  18  inch  diapers  of  bird's-eye  cotton. 


THE  NURSERY 

The  nursery  should  be  a  large  sunny  room,  with 
windows  facing  south.  Furnace  heat  is  to  be 
preferred  to  steam.  The  floors  should  be  of  hardwood, 
or  painted,  and  only  rugs  which  can  be  taken  up 
and  shaken  every  day  should  be  used.  The  floor 
should  always  be  cleaned  with  a  damp  cloth,  instead 
of  a  broom.  The  walls  should  be  painted  for  at  least 
four  feet  up  from  the  floor.  All  furniture  should  be 
of  the  simplest  kind;  the  beds  of  white  enamel  or 
brass,  and  few  curtains  or  other  hangings.  There 
should  always  be  a  thermometer  and  the  temperature 
kept  at  from  68°  F.  to  70°  F.  during  the  day,  and 
never  allowed  to  go  below  55°  F.  at  night.  For 
children  over  two  years  of  age  it  is  safe  to  allow  the 
temperature  of  the  room  to  go  a  little  below  55°  F.  at 
night  or  even  as  low  as  freezing-point.  Each  window 
should  have  a  light  and  dark  shade  so  that  the  room 
may  be  darkened  when  necessary.  A  good  way  to 
ventilate  the  room  is  by  means  of  the  window-board. 
This  is  a  board  four  inches  wide,  the  length  of  the 
window-sash,  which  fits  under  the  lower  sash,  raising 
it  so  that  there  is  an  opening  between  the  two  sashes 
through  which  a  current  of  air  comes  in  and  passes 
upward,  affording  excellent  ventilation  without  a 
draught. 

Food  should  not  be  allowed  to  stand  about.  No 
7 


S  THE  CHILD 

soiled   diapers   should   be   left   in   the    nursery,   nor 
should  they  be  washed  or  dried  in  that  room. 

A  child  should  have  its  own  crib.     The  best  kind, 


Tlie  Baby  Crib. 

as  shown  in  the  illustration,  has  one  side  that  can  be 
dropped  or  raised  up  and  locked  so  that  the  child 
cannot  get  out.  This  crib  may  be  used  also  as  an 
exercise  pen   for  very  young  children. 

For  the  new^-born  infant  a  bassinet  that  does  not 
rock  should  be  used  until  the  child  is  four  or  five 
months  of  age ;  then  the  bed  is  preferable. 


THE  CHILD  9 

For  the  mothers  who  do  not  wish  to  go  to  the  ex- 
pense of  a  bassinet,  an  ordinary  clothes-basket  with 
a  pillow  placed  in  the  bottom  makes  an  excellent  sub- 


ssiuet. 


stitute,  and,  although  not  so  showy,  has  the  advantage 
of  being  useful  for  other  purposes  after  the  child 
has  outgrown  it. 

An  infant  should  never  be  allowed  to  sleep  in  bed 
with  its  mother  or  nurse,  for  there  is  not  only  danger 
that  the  mother  may  lie  on  the  child  and  smother  it, 
but  if  the  baby  is  breast-fed  there  is  always  the  temp- 


10  THE  CHILD 

tation  to  feed  it  at  night  whenever  it  is  restless.  Un- 
less a  child  is  trained  to  sleep  in  its  own  bed,  it 
will  probably  be  wakeful  and,  so,  a  bad  habit  may 
result. 

The  child's  bed  should  be  provided  with  a  small 
hair  mattress,  protected  by  a  rubber  sheet,  over  which 
a  pad  should  be  placed  and  covered  with  a  sheet.  The 
pillow,  when  used,  should  be  made  of  the  finest  curled 
hair  and  large  enough  to  reach  well  beneath  the 
child's  shoulders. 

A  baby  should  not  lie  in  one  position  all  the  time, 
but  should  be  turned  from  side  to  side. 

A  gas  stove  should  never  be  used  to  heat  the  nursery 
except  for  a  few  minutes  while  the  baby  is  having  its 
bath;  and  a  gas-jet  should  not  be  allowed  to  burn  in 
the  room  at  night.  If  electric  light  is  not  to  be  had 
a  wax  candle  can  be  lighted  when  necessary. 


THE  NURSERY-MAID 

The  selection  of  a  nursery-maid  is  very  important. 
Before  she  is  engaged  she  should  be  examined  by  the 
physician  of  the  family  to  ascertain  if  she  has  any 
physical  disability  that  would  be  dangerous  to  chil- 
dren. The  following  qualifications  are  essential :  She 
should  be  cleanly  in  her  person  and  in  her  habits; 
she  should  have  no  decayed  teeth ;  she  should  be  free 
from  all  communicable  diseases,  such  as  tuberculosis, 
syphilis,  or  vaginal  discharge;  her  mental  condition 
should  be  sound;  she  should  have  an  even,   good- 


THE  CHILD  11 

natured  disposition;  and  she  should  be  absolutely 
trustworthy.  She  should  enjoy  the  care  of  children, 
have  tact  to  amuse  and  keep  them  happy,  and  be  able 
to  answer  their  questions  intelligently  and  look  out 
carefully  for  their  wants. 

There  are  training-schools  for  nursery-maids  in 
New  York  and  other  cities,  but  many  young  women 
may  be  taught  in  a  short  time  their  duties  and  make 
excellent  nursery-maids.  Middle-aged  women  are 
often  preferable  as  they  are  less  apt  to  have  their 
minds  distracted  by  beaux,,  going  out,  etc.,  often  give 
better  service,  and  are  more  contented  with  their  work. 


TOYS 

Such  a  topic  may  seem  to  some  out  of  place  in  a 
book  of  this  kind,  but  it  is  really  important  for  every 
parent  to  know  what  playthings  should  be  allowed 
in  the  nursery. 

Children  are  easily  pleased  and  amused;  therefore, 
simple  inexpensive  toys  will  bring  just  as  much  joy 
as  the  more  elaborate  and  expensive  ones. 

In  the  selection  of  toys  the  aim  should  be  to  educate 
the  child  and  develop  its  imagination.  For  this  pur- 
pose, such  toys  as  picture-books,  balls,  blocks,  boats, 
locomotives,  cars,  automobiles,  and  soldiers  are  best 
for  boys;  while  for  girls,  dolls,  doll-carriages,  doll- 
houses,  doll-furniture,  picture-books,  etc.,  answer  best. 

Care  should  be  taken  not  to  allow  children  to  Have 
playthings  that  are  painted,  because  the  paint  can  be 


12  THE  CHILD 

sucked  off,  and  toys  covered  with  hair  or  wool  should 
be  excluded,  as  the  hair  or  wool  is  sure  to  be  pulled 
off  and  put  into  the  mouth.  All  small  objects,  such 
as  marbles,  coins,  buttons,  beans,  beads,  rings,  small 
bells,  etc.,  are  dangerous,  as  they  are  frequently 
swallowed  or  pushed  into  the  nose  pr  ear.  No  toys 
with  sharp  points  or  points  easily  broken  off  should 
be  allowed,  as  these  are  a  menace  to  the  eyes.  The 
great  tendency  of  young  children,  as  we  all  know,  is 
to  put  everything  within  reach  into  the  mouth.  This 
danger  should  be  always  present  in  the  mother 's  mind, 
and  the  most  watchful  care  exercised  to  prevent  such 
a  mishap. 


THE  TRAINED  NURSE 

In  severe  illness  a  trained  nurse  is  almost  indis- 
pensable, and  even  in  less  serious  cases  her  services 
should  be  employed  whenever  possible.  Her  skilled 
care  will  add  greatly  to  the  comfort  of  the  child  and 
may  do  much  toward  bringing  about  a  favorable  ter- 
mination of  the  disease. 

A  trained  nurse  should  never  be  on  duty  for  more 
than  twelve  hours  at  a  time,  for  a  tired  nurse  cannot 
give  a  sick  baby  the  care  it  requires.  When  a  child 
is  so  sick  as  to  require  constant  attention,  two  nurses, 
one  for  the  night,  and  one  for  the  day,  should  be 
employed. 

A  very  good  mother  may  make  a  poor  nurse.  She 
is  apt  to  be  so  worried  and  nervous  when  her  own 


THE  CHILD  13 

child  is  the  patient  that  her  judgment  is  impaired, 
and  she  may  be  forgetful,  and  not  realize  the  import- 
ance of  those  little  things  that  are  so  essential  to  the 
child's  comfort,  such  as  bathing  or  sponging  as  often 
as  directed,  or  washing  the  eyes,  or  irrigating  the 
ears.  The  mother  is  apt  to  put  too  many  covers  over 
the  baby  and  to  keep  the  windows  closed  when  they 
are  ordered  open.  She  is  apt  to  give  too  much  or  too 
strong  food,  etc.,  and  not  infrequently  she  may  be 
influenced  in  the  care  of  the  child  more  by  what 
friends  and  relatives  advise  than  by  what  the  doctor 
directs. 

A  mother,  in  attempting  to  care  for  her  own  sick 
child,  often  breaks  down  with  the  strain  and  worry. 

She  would,  perhaps,  make^  an  excellent  nurse  for 
the  child  of  another,  though  it  might  be  quite  unsafe 
for  her  to  have  the  whole  care  of  her  own. 


CARE   OF  THE   NEW-BORN  BABE 

The  cord  having  been  tied  with  a  piece  of  silk  tape, 
the  child  should  be  wrapped  in  a  warm  woolen 
blanket  and  put  in  a  warm  room.  Two  drops  of  a 
two  per  cent  solution  of  nitrate  of  silver  should  be 
dropped  into  each  eye  with  an  eye-dropper.  The 
whole  body  should  now  be  thoroughly  oiled  to  remove 
the  ver.nix  caseosa,  and  then  the  child  should  be  given 
a  warm  h^ath  at  a  temperature  of  100°  F.  This  should 
be  done  in  a  warm  room,  preferably  in  front  of  an 
open  fire.     The  mouth  should  be  cleansed  with  a  soft 


14  THE  CHILD 

cloth  and  tepid  water  and  great  gentleness  should  be 
used. 

The  cord  should  be  thoroughly  dusted  with  an  ab- 
sorbent powder,  such  as  borated  talcum,  and  wrapped 
in  sterile  gauze  or  soft  old  linen,  over  which  a  pad 
of  sterile  gauze  or  old  linen  should  be  placed.  The 
abdomen  should  be  wrapped  with  a  soft  flannel  binder 
and  the  binder  securely  pinned.  Next  to  the  abdom- 
inal band  should  be  placed  a  soft  shirt  of  silk  and 
wool,  or  silk  and  cotton,  and  a  soft  diaper,  preferably 
of  old  linen,  put  on  and  pinned  to  the  shirt.  Over 
these  garments  a  soft  slip  of  nainsook  should  be  placed 
in  summer,  or  a  soft  Shaker  flannel  slip  in  winter. 

Before  placing  the  baby  in  the  crib  the  hands  and 
feet  should  be  examined  to  see  if  they  are  blue  or 
cold,  and  if  so,  hot  water-bottles  enveloped  in  flannels 
should  be  placed  in  the  crib,  about  the  body,  but  not 
touching  it.  The  baby  should  be  kept  in  a  slightly 
darkened  room  at  first. 

A  very  convenient  and  unique  method  of  dressing 
and  undressing  an  infant,  which  I  advise  and  most 
German  nurses  employ,  is  to  use  a  small  table  (the 
ordinary  folding  card-table  does  very  well)  about  two 
feet  square  which  is  thickly  padded  over  the  top  and 
protected  by  a  rubber  sheet. 

The  baby  is  laid  on  the  table,  where  it  can  be  easily 
got  at  to  put  on  or  take  off  its  clothes,  to  cleanse  its 
mouth  and  nose,  or  wash  out  its  eyes,  or  dry  and 
powder  it  after  the  bath.  In  Germany  special  tables 
are  made  for  this  purpose  with  drawers  containing 
the  different  toilet  articles,  etc. 


THE  CHILD 


15 


THE  BATH 


The  new-born  babe  should  receive  a  daily  basin 
bath  in  boiled  water  at  a  temperature  of  100°  F.,  using 
Castile  soap.  This  method  of  bathing 
should  be  continued  until  after  the  cord 
dries  up  and  drops  off,  and  the  navel 
is  healed.  At  this  time  the  child  should 
only  remain  in  the  bath  from  three  to 
four  minutes,  being  rubbed  while  in  the 
bath  all  over  with  the  hand  or  a  soft 
wash-cloth  (never  with  a  sponge),  then 
dried  quickly  with  a  soft  bath  towel. 
The  bath  should  always  be  given  in  a 
warm  room  kept  at  a  temperature  of 
74°  to  76°  P.,  with  all  doors  and  win- 
dows closed,  and  preferably  in  front  of 
a  fire. 

After  the  fourth  month,  if  the  child  is 
vigorous,  the  bath  may  be  given  at  a 
temperature  between  90°  and  95°  F. 
At  the  twelfth  month  the  temperature 
of  the  water  in  the  bath  may  be  gradu- 
ally reduced  from  90°  F.  in  the  begin- 
ning to  80°  F.  by  adding  cold  water, 
rubbing  the  child  meanwhile  vigorously 
with  the  hand.  After  the  baby  has  been 
washed  and  dried,  all  the  folds  of  the 
skin,  armpits,  genitals,  buttocks,  etc.,  should  be  thor- 
pughly  powdered. 


Bath 
Thermometer. 


16  THE  CHILD 

Before  placing  the  child  in  the  bath  the  head  and 
face  should  be  washed  with  a  soft  w^ash-cloth. 

Baths  serve  a  useful  purpose  in  many  ways  other 
than  cleanliness,  and  are  of  great  aid  as  therapeutic 
agents : — 

Tub  Baths  for  Fever. — Place  the  child  in  water 
at  a  temperature  of  95°  F.,  cold  w^ater  being  added 
until  the  temperature  is  75°  or  80°  F. 

The  child  should  not  remain  in  the  bath  for  more 
than  fifteen  minutes,  and  while  there  should  be  con- 
stantly rubbed  with  the  hand  from  head  to  foot. 

The  Sponge  Bath  for  Fever. — One  part  of  alcohol 
to  four  parts  of  water  at  a  temperature  of  70°  F.  are 
used.  The  child  should  be  stripped,  and  sponged 
under  a  blanket  with  a  soft  wash-cloth  for  fifteen 
minutes. 

In  an  emergency,  for  sudden  high  fever  either  the 
tub  bath  or  the  sponge  bath  may  be  used  to  reduce 
the  temperature,  but  should  not  be  repeated  except 
under  the  direction  of  a  physician. 

The  Tepid  Bath. — This  should  be  given  at  a  tem- 
perature of  95°  to  100°  F.  "When  children  are  restless 
and  irritable,  a  tepid  bath  will  frequently  soothe  and 
quiet  them  and  induce  quiet  sleep. 

Bathing  in  Hot  Weather. — During  the  extremely 
hot  weather  a  basin  bath,  given  by  sponging  the  child 
all  over  several  times  a  day  with  cool  water,  or  water 
mixed  with  a  little  alcohol,  will  give  much  comfort 
and  relief  and  make  a  trying  season  endurable. 

The  Mustard  Bath. — This  is  prepared  by  adding 
four  tablespoons  of  powdered  mustard  to  four  gallons 


THE  CHILD  17 

of  water  heated  to  a  temperature  of  105°  F.  The 
tnustard  is  first  rubbed  into  a  thick  paste  by  adding  a 
little  cold  water,  then  mixed  thoroughly  with  the  hot 
water.  The  child  should  be  constantly  rubbed  while 
in  the  bath. 

A  hot  mustard  bath  is  useful  in  collapse,  shock, 
convulsions,  sudden  heart  failure,  and  prostration. 

The  Bran  Bath. — This  is  made  by  hanging  a  cheese- 
cloth bag  containing  a  quart  of  wheat  bran  in  a  tub  of 
four  gallons  of  tepid  water.  The  bag  should  be  fre- 
quently scfueezed  and  moved  about  in  the  water  until 
the  water  looks  like  thin  gruel.  The  bran  bath  is  of 
great  service  where  the  skin  is  extremely  delicate,  or 
there  is  eczema,  or  scalds  from  wet  diapers,  highly  acid 
urine,  perspiration,  or  excoriations  produced  by 
diarrhoea,  etc. 

Soda  Bath. — This  is  prepared  by  adding  a  table- 
spoonful  of  bicarbonate  of  soda  to  a  quart  of  water. 
Sponge  the  child  lightly  from  a  basin  for  four  or  five 
minutes  and  then  allow  the  skin  to  dry  without  using 
friction.  The  soda  bath  is  especially  good  to  relieve 
the  intense  itching  from  prickly  heat  rash. 

The  Starch  Bath. — ^lix  one  or  two  tablespoons 
of  laundry  starch  with  a  gallon  or  two  of  water. 
Sponge  the  child,  and  dry  with  a  soft  towel,  without 
friction,  in  the  same  way  as  when  the  soda  bath  is 
used.  The  starch  bath  is  given  where  there  is  irri- 
tation of  the  skin,  as  in  hives,  prickly  heat,  redness 
and  excoriation  of  the  legs  and  buttocks  from  wet 
diapers  or  diarrhoea,  or  too  acid  urine  or  stools. 

The  Salt  Bath. — This  is  made  by  adding  a  table- 


18  THE  CHILD 

spoonful  of  salt  to  a  gallon  of  water.  It  acts  as  a 
tonic,  and  is  especially  good  for  delicate  and  poorly 
nourished  children.  The  child  is  first  washed  with 
soap  and  plain  water,  and  then  put  in  the  salt  water 
bath  and  dried,  without  rinsing  in  plain  water. 


THE  RUBBER   TUB 

This  is  a  Very  convenient  thing  to  have,  both  for 
babies  and  older  children,  for  besides  being  useful  in 
the  nursery,  it  can  be  folded  into  a  small  package  and 


Rubber  Tub. 

carried  about  from  room  to  room  or  from  place  to  place 
when  traveling.  It  is  almost  a  necessity  when  going 
to  the  country  for  the  summer,  especially  if  the  coun- 
try house  has  no  running  water.  The  tub  is  large 
enough  to  be  used  by  good-sized  children,  or  adults 
if  desired. 


THE  CHILD  19 

CLOTHING 

It  is  essential  that  infants'  clothing  should  be  soft 
and  non-irritating,  to  the  skin,  light  and  warm.  All 
garments  should  be  made  loose  enough  to  allow  the 


Denton  Nightdress. 

arms  and  legs  to  be  moved  freely  as  well  as  giving 
plenty  of  room  about  the  abdomen  and  chest.  Care 
should  be  taken  that  bands  are  not  pinned  so  tightly 
about  the  chest  or  abdomen  as  to  prevent  free  ex- 
pansion. A  woolen  shirt  of  soft  texture  should  be 
worn,  and  the  petticoats  supported  from  the  shoulders, 
never  from  the  waist. 

A  soft  flannel  abdominal  band  is  worn  for  the  first 
few  weeks  and  this  is  supplanted  by  a  knitted  band 
with  shoulder-straps. 

Canton  flannel  makes  the  best  absorbent  diapers  for 
young  babies  as  they  are  more  pliable  and  softer 
than  the  linen.  It  is  very  important  that  the  young 
baby's  feet  be  kept  warm,  as  cold  feet  are  frequently 
the  cause  of  colic  and  indigestion.     When  the  circula- 


20 


THE  CHILD 


tion  is  poor  a  hot  water-bag  should  be  kept  at  the  foot 
of  the  bed. 

In  summer  the  clothing  should  be  light  and  loose, 
and  that  worn  next  to  the  skin  of  the  thinnest  flannel 


Union  Suit. 


or  gauze.  Changes  in  the  temperature  are  best  met 
by  the  addition  of  outer  wraps.  In  a  changeable 
climate  like  New  York  it  is  a  foolish  fashion  to  have 
children  go  with  bare  legs,  since  delicate  children  may 
suffer  from  this  method  of  trying  to  harden  them. 


THE  CHILD  21 

The  night  clothing  of  an  infant  should  consist  of  a 
loose-fitting  soft  flannel  slip.  Older  children  should 
wear  a  union  suit  with  waist  and  trousers  and  feet, 
especially  if  there  is  a  tendency  to  kick  the  cover  off. 

Care  should  be  taken  not  to  overload  children  with 
covers  at  night.  This  tendency  is  frequently  the  cause 
of  restlessness  and  sleeplessness. 


CARE  OF  THE  EYES 

The  eyes  should  be  protected  from  too  strong  light 
during  early  infancy,  and  a  child  should  sleep  in  a 
darkened  room.  For  a  few  days  after  birth,  the 
baby's  eyes  should  be  washed  once  a  day  with  a  satu- 
rated solution  of  boracic  acid.  Eye-washes  should 
never  be  used  except  under  the  direction  of  a  physi- 
cian. 

CARE  OF  THE  MOUTH  AND  TEETH 

The  mouth  of  a  new-born  babe  should  be  gently 
cleansed  each  morning  with  boiled  water  and  a  soft 
cloth,  care  being  taken  not  to  injure  the  delicate 
mucous  membrane  lining  of  the  mouth.  When  thrush 
or  sprue,  which  looks  like  fine  milk  curds  on  the 
tongue  or  mucous  membrane,  appears,  a  saturated 
solution  of  boracic  acid  should  be  used  as  a  cleansing 
agent  after  each  feeding.  This  is  best  applied  by 
wrapping  the  finger  with  absorbent  cotton,  dipping  it 
in  the  solution,  and  washing  out  the  mouth. 


22  THE  CHILD 

It  is  exceedingly  important  that  the  milk-teeth 
should  have  daily  care,  since  dirty  teeth  cause  bad 
breath,  indigestion,  and  if  not  carefully  watched  are 
sure  to  become  decayed,  with  resulting  neuralgia  and 
bad  breath,  making  in  time  an  unhealthy  child. 

Decayed  teeth  should  be  filled,  when  possible,  with 
a  soft  filling.  If  this  is  not  possible,  they  should  be 
pulled.  A  child  should  be  taken  to  a  dentist  once 
every  six  months.  The  teeth  should  be  cleansed  with 
a  soft  brush  and  a  simple  tooth  powder,  such  as  pre- 
cipitated chalk,  once  every  day. 

Oil  Wintergreen 3  drops 

Boracic  Acid   Vs  dram 

Precipitated  Chalk 1  ounce 


APPEARANCE  OF  THE  TEETH 

There  are  twenty  milk-teeth,  and  the  time  at  which 
they  appear  varies  considerably  even  in  a  normal  child. 

Some  few  children  are  born  with  a  tooth,  some  get 
them  at  the  fourth  or  fifth  month,  and  some  not  until 
the  tenth  month. 

The  average  time  of  teething  is  as  follows: 

Two  lower  incisors   6  to     9  months 

Four  upper  incisors 8  to  12       " 

Two   lower   lateral  incisors  and 

four   anterior  molars    12  to  15       " 

Four  canines 18  to  24       " 

Four  posterior  molars   24  to  30      " 


THE  CHILD  23 

At  1  year  a  child  should  have  6  teeth. 
At  IVa  years  a  child  should  have  12  teeth. 
At  2  years  a  child  should  have  16  teeth. 
At  2!4  years  a  child  should  have  20  teeth. 

Before  the  tooth  appears  the  gum  becomes  some- 
what reddened  and  inflamed,  there  is  some  salivation 
of  the  mouth,  and  the  child  is  often  fretful.  Children 
that  have  been  properly  fed  from  birth  rarely  have 
any  difficulty  in  cutting  their  teeth,  but  in  cases  where 
the  milk  has  not  been  properly  adapted,  difficult  den- 
tition is  apt  to  follow,  with  the  accompanying  symp- 
toms of  fretfulness,  slight  fever,  indigestion,  and  some- 
times diarrhoea.  When  the  gum  is  red,  and  swollen 
around  a  coming  tooth,  the  spot  should  be  rubbed 
with  a  coarse  towel  held  over  the  finger  to  break  the 
mucous  membrane,  but  the  gum  should  not  be  lanced. 

Rickets  is  the  commonest  of  all  causes  of  delayed 
teething,  and  children  with  rickets  are  very  late  in 
teething. 

MILK  IN  INFANTS'  BREASTS 

Mothers  are  often  very  much  worried  by  the  appear- 
ance of  milk  in  an  infant's  breast  (sometimes  in  quite 
large  quantities),  causing  marked  bulging  of  the 
breasts.  In  each  case  no  attempt  should  be  made  to 
squeeze  the  milk  out,  as  by  so  doing  serious  injury- 
may  be  caused. 

I  have  had  a  number  of  cases  brought  to  me  where 
the  breasts  have  been  thus  tampered  with,  and  an  ab- 
scess of  the  breast  resulted  which  required  a  surgical 


2i  THE  CHILD 

operation    and    was    even    a    menace    to    the    child's 
life. 

Infants  with  milk  in  the  breasts  should  have  a 
snug  bandage  applied  over  the  breasts,  and  no  other 
treatment  except  as  advised  by  a  physician. 


HOW  TO  LIFT  THE  BABY  AND  YOUNG  CHILD 

Every  one  who  has  anything  to  do  with  a  baby 
should  know  the  proper  way  of  lifting  it  in  order  to 
avoid  injury.  One  hand  should  be  placed  under  the 
buttocks  and  the  other  hand  and  arm  at  the  back  of 
the  head,  neck,  and  shoulders ;  there  then  is  no  danger 
of  straining  the  back  or  injuring  the  extremities. 
Premature  or  very  delicate  children  may  be  laid  on  a 
pillow  and  carried  about  in  that  way.  Children  of 
the  runabout  age,  when  lifted  from  the  ground,  should 
be  taken  with  both  hands  about  the  body  just  under 
their  armpits.  They  should  never  be  lifted  by  one 
arm,  as  unfortunately  is  too  often  carelessly  done  by 
nurse-maids,  nor  should  a  child  ever  be  lifted  by  the 
ears  or  head.  I  knew  of  one  child  that  was  made  a 
cripple  for  life  by  being  lifted  by  the  head. 


THE  HEALTHY  BABY 

In  order  to  appreciate  what  constitutes  illness,  or 
failure  to  grow,  it  is  necessary  to  know  what  to  look 
for  in  the  healthy  child.  First  of  all,  the  great  func- 
tion of  the  child  is  to  grow,  as  steady  growth  is  essen- 


THE  CHILD  25 

tial  to  health.  The  gain  in  weight  should  be  from 
five  to  eight  ounces  a  week,  the  tiesh  should  be  firm, 
the  eyes  bright,  and  the  skin  clear. 

There  should  be  two  or  three  soft  yellow  stools  each 
day.  The  child  should  be  hungry  at  feeding  time  and 
U.ke  the  breast  or  the  bottle  eagerly  when  it  is  offered, 
or  cry  lustily  when  it  is  long  delayed  past  the  proper 
time,  but  should  be  satisfied  and  contented  when  fed, 
and  when  nursing  is  finished  should  usually  fall  asleep. 
Healthy  babies  may  cry  from  other  causes  besides 
hunger,  such  as  the  prick  of  a  pin,  too  tight  clothing, 
or  transient  pain  of  any  kind.  The  process  of  dressing 
or  undressing,  or  the  sight  of  strangers,  may  cause 
them  to  cry.  The  healthy  baby  should  sleep  quietly 
and  awaken  bright  and  refreshed. 

After  the  second  month,  the  healthy,  normal  child 
begins  to  notice  things  and  people,  and  is  attracted  by 
toys,  bright  objects,  or  noises.  From  the  third  to 
the  fifth  month  it  should  hold  its  head  erect  without 
support.  From  the  seventh  to  the  tenth  month  it 
should  be  able,  to  sit  alone,  and  at  this  time  teething 
begins.  At  the  fifth  or  eighth  month  the  child  should 
begin  to  creep  on  all-fours,  and  by  the  tenth  month 
should  make  attempts  to  stand.  From  the  twelfth 
to  the  eighteenth  month  it  learns  to  walk,  and  by  the 
seventeenth  month  will  usually  walk  alone.  When  a 
baby  is  born  it  is  usually  deaf  for  about  four  days. 
The  hearing  gradually  develops  so  that  by  the  fourth 
or  fifth  week  this  sense  is  very  acute  and  loud  noises 
disturb  the  child.  The  sense  of  taste  also  gradually 
devjelops  from  the  first  week  up  to  the  sixth  month, 


26  THE  CHILD 

though  by  the  fourth  or  fifth  day  the  child  can  dis- 
tinguish between  sweetened  or  unsweetened  milk. 
After  the  tenth  month  a  child  will  remember  the  face 
of  a  parent  after  a  short  absence,  and  after  the  twenty- 
first  or  twenty-second  month  will  remember  persons 
who  have  been  away  for  some  time. 

Children  vary  as  to  the  time  when  they  begin  to 
talk,  but  generally  they  should  be  able  to  say  ^  ^  papa  ' ' 
and  ^ '  mama  ' '  by  the  twelfth  to  the  fourteenth  month, 
and  should  formulate  short  sentences  by  the  twenty- 
fourth  month. 

Healthy  children  vary  within  certain  limits  as  to 
weight  and  height.  During  the  first  two  or  three 
dsiys  following  birth  a  baby  frequently  loses  from  five 
to  seven  ounces,  but  usually  by  the  seventh  day  this 
loss  is  made  up.  However,  when  the  baby  is  placed 
at  once  at  the  breast  there  may  be  little  or  no  loss. 
Up  to  the  fourth  month  a  child  gains  nearly  an  ounce 
a  day,  or  from  one  and  a  half  to  two  pounds  a  month. 
An  infant  should  double  its  weight  in  five  months. 
From  the  fourth  to  the  twelfth  month  there  should 
be  a  gain  of  from  one-half  to  tw^o-thirds  of  an  ounce 
each  day,  or  about  a  pound  a  month,  and  at  the  twelfth 
month  a  baby  should  have  trebled  its  birth  weight. 

The  well-nourished  child  should  grow  about  eight 
inches  the  first  year,  which  would  be  on  an  average 
almost  three-fourths  of  an  inch  a  month.  During  the 
second  year  the  growth  is  not  so  rapid,  about  four 
inches,  or  about  one-third  of  an  inch  on  an  average 
a  month,  while  the  weight  increases  about  twelve 
ounces  per  month. 


THE  CHILD  27 

When  a  child  does  not  gain  at  the  rate  of  an  aver- 
age of  a  pound  a  month  during  the  first  year,  and 
three-quarters  of  a  pound  a  month  the  second  year, 
presumably  the  food  is  at  fault. 

Every  baby  under  one  year  of  age  should  be  weighed 


The  Healthy  Child  Fourteen  Months  of  Age. 

once  a  week,  and  those  who  are  having  a  change  in 
diet  because  of  failure  to  grow,  as  well  as  weak  and 
delicate  children,  should  be  weighed  several  times  a 
week.  When  a  child  is  gaining  at  the  rate  of  six 
or  eight  ounces  a  week  we  may  have  no  fear,  but  where 


25  -         THE  CHILD 

the  gain  is  only  four  or  five  ounces  careful  watching 
and  frequent  weighing  are  desirable,  even  though  the 
child  seems  perfectly  healthy. 

The  gain  in  weight  is  always  considerably  less  dur- 
ing the  summer  months  than  in  cooler  weather,  and 
not  infrequently  there  is  scarcely  any  gain  during 
midsummer. 

SCALES  FOR  WEIGHING 

The  most  satisfactory  scales  to  buy  are  the  ordinary- 
grocers '  scales,  with  the  scoop  for  weighing  small 
babies,  and  the  platform  for  older  children. 

These  scales  weigh  in  ounces,  so  that  accurate  weight 
may  be  obtained  no  matter  what  the  size  of  the  child. 
Some  prefer  to  get  the  little  spring  and  basket  scales 
to  weigh  the  baby.  These  weigh  in  ounces  up  to 
twenty-five  pounds  and  are  all  right  for  the  first  year, 
but  will  not  do  for  older  children. 

SLEEP 

A  young  infant  in  health  should  have  quiet,  peace- 
ful, but  not  deep,  sleep  during  the  first  month  of  its 
life.  The  sleep  of  childhood  after  the  third  year  is 
deep.  For  the  first  few  weeks  an  infant  should  sleep 
from  twenty  to  twenty-two  hours  out  of  the  twenty- 
four,  waking  only  to  take  its  food.  If  it  has  pain,  or 
is  uncomfortable  from  too  tight  clothing,  or  too  many 
covers,  or  from  any  other  cause,  such  as  hunger  or 
indigestion,  of  course  its  sleep  will  be  disturbed.     Dur- 


THE  CHILD 


29 


WEIGHT    AND    HEIGHT    OF    THE    WELL    CHILD 
FROM  BIRTH  TO   THE  SEVENTH  YEAR* 


AGE 

SEX 

WEIGHT 
POUNDS 

HEIGHT 
INCHES 

Birth 

Boys 

Girls 

7.55 

7.16 

20.6 
20.5 

6  months 

Boys 
Girls 

16.0 
15.5 

25.4 
25.0 

12  months 

Boys 
Girls 

20.5 
19.8 

29.0 

28.7 

18  months 

Boys 
Girls 

22.8 
-22.0 

30.0 
29.7 

2  years 

Boys 
Girls 

26.5 
25.5 

32.5 
32.5 

3  years 

Boys 
Girls 

31.2 
30.0  3cf 

35.0 

35.0     34 

4  years 

Boys 
Girls 

35.0 
34.0 

38.0 
38.0 

5  years 

Boys 
Girls 

41.2 
39.8 

41.7 
41.4 

6  years 

Boys 
Girls 

45.1 

48.8 

44.1 
43.6 

7  years 

Boys 
Girls 

49.5 
48.0 

46.2 
45.9 

*From  L.  E.  Holt's  "Diseases  of  lufancy  and  ChildliQOcl/ 


30  THE  CHILD 

ing  the  first  six  months  a  healthy  child  ought  to  sleep 
from  sixteen  to  eighteen  hours,  Avaking  every  two  or 
three  hours  during  the  day,  and  remaining  awake  from 
half  an  hour  to  an  hour  at  the  time  it  takes  its 
food. 

At  night  an  infant  should  have  a  period  of  five  or 
six  hours  of  uninterrupted  sleep,  and  after  about  the  - 
fifth  month  there  should  be  no  feeding  between  10  p.m. 
and  7  a.m.  When  a  child  has  reached  the  age  of  one 
year  it  should  sleep  fifteen  hours  during  the  twenty- 
four,  twelve  hours  at  night  and  three  hours  during  the 
day,  having  a  nap  in  the  morning  and  one  in  the 
afternoon.  During  the  second  year  one  nap  of  a 
couple  of  hours  is  usually  sufficient,  but  the  night  rest 
should  be  of  twelve  hours  duration.  A  child  four 
years  of  age  should  have  twelve  hours  of  sleep.  From 
the  sixth  to  the  tenth  year  eleven  hours,  and  from  the 
tenth  to  the  sixteenth  at  least  nine  hours,  are  neces- 
sary. 

The  daily  nap  should  be  kept  up  until  the  fourth  or 
fifth  year,  and  in  delicate  children  to  the  seventh 
year  or  longer. 

An  infant  should  be  trained  from  birth  to  go  to 
sleep  when  placed  in  its  crib.  It  should  never  be 
allowed  to  go  to  sleep  at  the  breast,  or  with  the  nipple 
of  a  bottle,  or  any  other  device  in  its  mouth. 

If  the  child  is  awakened  at  regular  feeding  intervals 
during  the  day,  and  allowed  to  sleep  as  long  as  possible 
during  the  night,  this  will  do  much  to  establish  regular 
.habits  of  sleep,  make  the  child  less  care  to  its  mother, 
and  help  to  insure  good  health. 


THE  CHILD  31 

An  infant  should  never  be  rocked  to  sleep,  but  should 
be  placed  in  its  crib  after  nursing,  care  being  taken 
that  its  diapers  are  dry  and  its  condition  warm  and 
comfortable,  and  that  the  room  is  darkened.  This 
should  represent  all  that  is  necessary  to  bring  peaceful 
quiet  sleep  to  the  healthy  child. 


EXCESSIVE  SLEEP 

Either  one  of  two  causes  may  bring  abotit  exces^jive 
sleep:  some  organic  disease  of  the  brain,  or  the  use 
of  certain  drugs. 

Opium,  usually  in  the  form  of  a  *'  soothing  syrup,'' 
or  paregoric  is,  in  most  cases,  the  drug  that  is  given. 
Excessive  sleep  should  arouse  the  suspicion  at  once, 
and,  if  investigation  shows  this  drug  has  been  given, 
the  child  should  be  taken  into  the  fresh  air,  kept  awake, 
and  the  doctor  sent  for,  as  serious  consequences  may 
result. 


EXERCISE 

A  young  infant  should  be  placed  on  a  large  bed  or 
mattress  each  day  for  an  hour,  with  nothing  but  a  loose 
shirt  and  diapers  on,  where  it  is  allowed  to  kick  its 
legs  and  wave  its  arms,  and  so  get  exercise  which 
strengthens  the  muscles  and  improves  the  appetite. 

The  child  also  gets  exercise  from  crying. 
•  After  the  eighth  month  and  up  to  the  second  year, 
when  the  child  begins  to  creep  and  w^alk,  it  will  require 


32  THE  CHILD 

less  watching  and  will  also  be  safe  from  cold  floors, 
draughts,  and  the  danger  of  falling  downstairs  or 
being  otherwise  injured,  if  it  plays  and  gets  the  ex- 
ercise— which  is  so  important — in  the  exercise  pen. 


The  Exercise  Yard  or  Pen. 

The  *^  pen  ''  consists  of  a  fenced-in  enclosure  about 
four  feet  square,  with  a  bottom  made  from  blankets 
or  a  mattress,  and  is  so  constructed  that  it  can  be 
folded  up  and  easily  carried  from  place  to  place. 

Older  children  should  be  encouraged  to  take  every 
form  of  outdoor  exercise. 

Delicate  children  should  have  their  exercise  regu- 
lated, and  it  should  never  be  allowed  to  go  far  enough 
to  produce  a  state  of  exhaustiou, 


THE  CHILD  33 

AIRING 

In  the  summer  it  is  not  only  perfectly  safe  to  take 
a  baby  a  week  or  ten  days  old  out-of-doors,  but  it 
should  be  kept  in  the  air  as  much  as  possible  during 
the  day  when  the  weather  is  good,  taking  care  to  pro- 
tect it  from  the  sun,  wind,  and  flies.  In  the  spring 
and  fall  it  is  best  not  to  take  a  baby  out  before  it 
is  a  month  old,  and,  then,  only  when  the  weather  is 
mild.  At  first  the  outing  should  be  for  half  an  hour, 
then  gradually  lengthenipg  the  time  to  two  or  three 
hours  as  the  child  becomes  accustomed  to  the  out-of- 
door  air. 

Babies  that  are  born  in  the  late  fall  or  winter  can 
be  given  an  indoor  airing  by  dressing  them  in  their 
outdoor  garments  and  opening  the  windows  of  the 
nursery. 

By  the  time  a  child  is  four  or  five  months  old  it 
can  be  taken  out  for  its  daily  airing  with  benefit,  even 
in  winter,  if  properly  protected  from  the  cold ;  except 
during  very  severe  or  windy  days,  or  when  the  air 
is  damp  by  reason  of  melting  snow. 


THE  BABY  TENDER 

This  consists  of  a  light,  but  strong,  wooden 
frame  supported  on  castors,  as  shown  in  the  illustra- 
tion of  the  Glascock  baby  walker.  To  the  top  or 
body  ring  is  attached  an  adjustable  saddle,  and  the 
whole  weight  of  the  child  is  supported  by  steel  springs, 


34 


THE  CHILD 


thus  allowing  the  child's  feet  to  touch  the  floor.  A 
baby  five  or  six  months  old  will  at  first  use  it  as  a 
jumper,  but  before  very  long,  in  its  efforts  to  walk, 


The  Glascock  Baby  Walker. 


it  will  push  it  about  the  room.  The  baby  tender  allows 
the  child  to  sit  or  stand,  walk  or  jump,  the  weight 
of  its  body  being  supported  by  the  springs.  This 
enables  the  baby  to  get  proper  exercise,  strengthens 
the  legs,  and  avoids  the  danger  of  its  becoming  bow- 
legged.     While  the  baby  tender  is  a   valuable  help 


THE  CHILD  35 

in  the  nursery,  it  should  not  be  abused.  Care  should 
be  taken  that  the  child  is  not  left  in  it  long  enough 
to  become  tired,  and  that  it  is  not  used  too  often. 


THE  CRY 

It  is  perfectly  normil  and  necessary  that  the  young 
infant  should  do  a  little  crying  each  day.  This  ex- 
ercises the  muscles  of  the  body,  causes  the  child  to 
breathe  deeply,  expands  its  lungs,  oxygenates  the 
blood,  and  stimulates  the  action  of  the  bowels. 

When  crying  is  long  and  continuous,  however,  it 
becomes  abnormal,  and  the  cause  should  be  looked 
into,  and,  if  possible,  remedied.  Children  nuiy  cry 
from  pain,  hunger,  temper,  fright,  illness,  or  habit. 

The  cry  of  pain  is  loud  and  continuous,  as  in  colic, 
earache,  or  difficult  movements  of  the  bowels. 

The  cry  of  hunger  is  that  which  comes  at  the  regular 
feeding  times  when  the  food  is  withheld,  and  is  at 
once  quieted  when  food  is  given,  and  is  not  heard 
again  until  the  next  feeding  time,  unless  the  baby 
is  not  satisfied,  when  crying  may  occur  again  soon 
after  nursing. 

The  cry  of  illness  is  peevish  and  whining,  but  it 
may  be  vigorous,  and  children  that  are  painfully  ill 
sometimes  cry  for  an  hour  or  two  until  they  become 
quite  exhausted  and  fall  alseep. 

There  is  nothing  distinctive  about  the  cry  of  fright, 
but  it  is  usually  loud  and  of  short  duration. 

The  cry  of  indulgence  is  easily  distinguished,  as  it 


36  THE  CHILD 

is  the  practice  of  spoiled  or  badly  managed  children, 
who  when  left  alone  may  cry  vigorously  until  they 
are  taken  up  and  held  in  the  arms,  or  walked  with, 
talked  to,  or  rocked;  then  the  cry  immediately  ceases, 
and  we  know  that  pain  or  discomfort  was  not  the 
cause. 

When  a  baby  cries  at  night  it  should  be  examined 
to  see  that  it  has  not  too  many  covers  over  it,  or  too 
few,  or  that  its  clothing  is  not  too  tight ;  it  may  be  that 
a  pin  is  pricking  it  or  that  it  has  a  soiled  diaper,  or 
its  hands  or  feet  are  cold,  or  it  may  have  colic. 

If  none  of  these  causes  are  present,  the  bottle  of 
milk  should  be  examined  to  see  if  it  is  sweet,  as  that 
may  be  at  the  root  of  the  trouble. 


TEMPERATURE 

Under  normal  conditions  the  temperature  of  an  in- 
fant or  young  child  varies  from  98°  to  99.5°  F.  "When 
fever  is  present  the  temperature  of  an  infant  is  always 
higher  than  it  would  be  in  an  adult  from  the  same 
cause.  Every  mother  should  have  a  thermometer  for 
taking  the  baby's  temperature  and  know  how  to  use 
it.  The  hand  is  not  a  reliable  guide  in  judging  the 
degree  of  temperature,  as  fever  is  not  perceptible  to 
this  test  below  101°  or  102°  F. 

The  thermometer  should  be  first  shaken  down,  then 
thoroughly  greased  with  oil  or  vaseline  and  inserted 
into  the  rectum  until  the  mercury  is  entirely  out  of 
sight,  and  left  there  for  at  least  three  minutes. 


THE  CHILD  37 

The  thermometer  cannot  be  successfully  held  in  a 
baby's  mouth,  and  the  temperature  taken  from  the 
axilla  is  very  unreliable. 

The  family  physician  should  show  the  mother  how 
to  use  the  thermometer  and  how  to  take  the  reading. 


KISSING 

Promiscuous  and  general  kissing  of  babies  and 
young  children,  as  a  practice,  cannot  be  too  strongly 
condemned.  The  contagious  diseases — diphtheria,  in- 
fluenza, tonsillitis,  tuberculosis,  and  syphilis — may  be, 
and  often  are,  transmitted  in  this  way.  For  this 
reason  kissing  should  be  allowed  only  to  the  immediate 
family,  and  then  only  to  those  members  who  are  in 
perfect  health.  Even  under  these  circumstances  a 
child  should  never  be  kissed  upon  the  mouth  or  on 
the  hands;  the  safest  place  is  the  forehead. 

Older  children  should  be  taught  to  turn  their  cheek 
when  strangers  insist  upon  kissing  them. 

Servants  and  nurses  should  be  warned  never  to 
kiss  the  child  on  penalty  of  dismissal. 


CARE  OF  THE  BREASTS  AND  NIPPLES 

When  a  mother  first  begins  nursing  her  child  the 
nipples  are  very  often  soft  and  tender,  and  have  to 
be  gradually  hardened  and  accustomed  to  the  office 
they  are  to  perform.     They  should  be  washed  gently 


38 


THE  CHILD 


before  and  after  nursing  with  a  saturated  solution 
of  boracic  acid.  This  is  best  done  with  a  piece  of 
absorbent  cotton.  Having  thoroughly  washed  the 
nipples,  vaseline  may  be  applied  on  sterile  gauze,  and 
allowed  to  remain  until  the  next  nursing,  when  the 


Nipple  Shield. 


English  Breast-Pump. 


nipples  should  again  be  washed  with  the  boracic  acid 
solution  before  the  child  is  put  to  the  breast.  After 
a  week  or  two  the  nipples  will  be  toughened  so  that 
the  vaseline  may  be  discontinued. 

Sometimes,  usually  from  neglect,  the  nipples  become 
cracked,  in  which  case  they  are  extremely  painful. 
The  baby  should  never  be  allowed  to  nurse  a  cracked 
nipple.  A  nipple  shield  should  always  be  used.  It 
may  require  some  patience  to  teach  the  baby  to  take 
the  breast  in  this  way.     It  is  very  important  that  a 


THE  CHILD  39 

nursing  mother  should  not  allow  her  breast  to  become 
hard  or  in  the  least  painful. 

Not  infrequently  at  first  when  the  milk  comes  into 
the  breast  with  a  rush,  as  it  often  does,  the  young  baby 
is  not  able  to  take  it  all,  and  to  empty  the  breasts,  in 
such  cases  the  remainder  of  the  milk  left  after  the 
baby  has  nursed  should  be  pumped  out  by  means 
of  the  breast-pump.  "When  hard  lumps  form  in  the 
breast  frequent  massage  with  warm  sweet  oil  or  vase- 
line usually  gives  relief,  and  prevents  the  formation 
.of  an  abscess.  In  some  cases,  when  the  lumps  in  the 
breasts  are  large,  the  massage  must  be  almost  constant 
for  hours,  or  even  a  whole  day  at  a  time,  to  alleviate 
the  condition  and  avoid  serious  consequences. 

While  the  breast  shields  are  being  used,  and  until 
the  cracked  nipples  are  entirely  healed,  the  nipples 
should  receive  treatment  between  each  nursing.  They 
should  be  washed  clean  with  the  saturated  solution  of 
boracic  acid,  dried,  and  then  equal  p^rts  of  zinc  oxide 
ointment  and  vaseline  should  be  applied  on  soft  old 
linen.  This  being  removed,  the  nipple  should  be 
cleansed  before  each  nursing  with  boracic  acid  solution 
or  plain  alcohol.  Some  mothers  have  large,  pendulous, 
and  flabby  breasts,  in  which  case  a  wide  bandage  about 
the  breasts  will  support  them  and  afford  great  comfort. 


MATERNAL  NURSING 

Every  mother  in  good  health  should  nurse  her  own 
child,  when  possible,  if  only  for  a  few  months,  for 


40  THE  CHILD 

she  is  thus  giving  her  child  the  best  chance  o£  de- 
velopment. It  is  not  only  better  for  the  mother,  but 
it  may  be  the  means  of  saving  the  baby's  life;  for 
there  is  no  artificial  food  that  is  ^^  just  as  good  ''  as 
good  mother's  milk,  or  that  can  be  modified  to  simulate 
it  exactly. 

A  great  many  well-to-do  mothers  who  could  do  so 
are  not  willing  to  nurse  their  babies  for  social  reasons. 
Many  mothers  of  the  poorer  class  take  the  same  course 
because  they  must  go  out  to  work. 

Through  an  investigation  by  the  Department  of 
Health,  in  1907,  into  the  methods  of  feeding,  25,865 
babies  under  nine  months,  and  34,692  babies  over  nine 
months  and  under  twenty-four  months,  showed  the 
percentage  of  breast-fed  was  large;  81.15  per  cent  of 
infants  under  nine  months  being  thus  nourished,  while 
only  18.85  per  cent  were  artificially  fed.  These  18.85 
per  cent  of  artificially  fed  infants  supplied  57.53  per 
cent,  or  over  one-half,  of  all  the  cases  of  diar- 
rhoea which  occurred  in  this  age  group  during  the 
year. 

We  may  therefore  say  in  round  numbers  that  a  child 
has  six  times  as  great  a  chance  of  being  afflicted  with 
summer  diarrhoea  when  fed  on  artificial  food  as  when 
it  is  breast-fed. 

Of  the  total  number  of  children  who  died  of  diar- 
rhoea under  nine  months  old  25.04  per  cent  had  been 
breast-fed,  while  74.96  per  cent,  or  three  times  as 
many,  had  been  artificially  fed. 

Of  the  children  over  nine  months  of  age,  23.72  per 
cent  were  breast-fed  during  their  first  year,  while 


THE  CHILD  41 

76.28  per  cent  of  the  deaths  occurred  in  children  who 
had  been  artificially  fed. 

Condensed  milk-fed  babies  had  a  larger  death  rate 
than  babies  fed  by  any  other  artificial  food. 

A  child  who  is  fed  by  the  mother  stands  a  much 
better  chance  in  a  fight  with  disease  than  one  who  is 
bottle-fed. 

For  instance,  in  New  York  City  about  5,000  babies 
die  each  year  of  diarrha?al  diseases,  about  3,750  be- 
ing the  artificially-fed  infants. 

There  are  many  mothers  who  cannot  nurse  their 
babies,  and  others  who  should  not  be  allowed  to  do  so ; 
among  these  last  may  be  mentioned  consumptives  and 
those  who  have  an  hereditary  tendency  to  tuberculosis. 
Women  who  are  pale,  anivmie,  or  delicate  make  poor 
wet-nurses.  Very  old  or  very  young  mothers,  or  those 
who  have  borne  many  children,  are  apt  to  have  a 
poor  milk  supply. 

Women  between  the  ages  of  twenty  and  thirty-five 
make  the  best  wet-nurses.  Nervous  and  impression- 
able women,  or  those  who  worry,  are  failures  at  nurs- 
ing. No  woman  should  nurse  her  child  after  she  has 
become  pregnant  again,  but  menstruation  is  not  a 
contra-indication  to  nursing. 

A  nursing  mother  should  not  worry,  or  have  cares, 
if  it  is  possible  for  her  to  avoid  them.  In  order  to 
nurse  her  child  successfully  she  must  be  happy  and 
contented.  Six  or  eight  hours  after  the  baby  is  born 
the  mother's  nipples  should  be  washed  with  a  satu- 
rated solution  of  boraeic  acid,  and  after  they  have  been 
dried  and  moistened  with  alcohol  the  baby  should  be 


42  THE  CHILD 

put  to  the  breast.  This  will  gradually  prepare  the 
breasts  and  nipples  for  the  milk — which  w411  appear 
in  from  forty-eight  to  seventy-two  hours  afterwards — 
and  will  accustom  them  to  their  new  use.  Then  when 
the  milk  does  come  the  baby  and  the  nipples  will  be 
in  readiness  for  it.  Until  the  milk  appears  the  baby 
may  be  given  sugar-water,  which  is  made  by  adding 
two  teaspoonfuls  of  milk-sugar  to  half  a  pint  of  boiled 
water,  or  plain  unsweetened,  boiled,  or  filtered  water. 
One-half  to  one  ounce  should  be  given  every  two  or 
three  hours. 

It  is  always  well  to  accustom  the  child  to  taking 
its  food  at  regular  intervals;  and  between  11  p.m.  and 
6  A.M.  there  should  be  only  one  nursing. 

A  child  should  gain  at  least  four  ounces  each  week : 
most  babies  gain  from  six  to  ten  ounces.  In  order 
to  keep  in  touch  with  the  child's  condition,  weekly 
weighings  should  be  made.  There  are  other  ways, 
however,  of  determining  whether  or  not  the  baby  is 
thriving.  If  a  baby  is  nursed  at  proper  intervals,  and 
the  milk  is  of  good  quality  and  sufficient  in  quantity, 
after  nursing  for  fifteen  minutes  it  should  seem  satis- 
fied, and  sometimes  appear  drowsy,  or  fall  asleep. 
When  the  nursing  time  again  comes,  the  baby  should 
be  hungry  and  restless,  crying  if  its  feeding  is  delayed, 
and  should  take  the  breast  eagerly  when  it  is  offered. 

On  the  other  hand,  a  child  who  does  not  get  sufficient 
nourishment,  either  because  the  milk  is  poor  in  qual- 
ity or  insufficient  in  quantity,  or  for  any  other  reason 
does  not  agree  with  it,  remains  longer  at  the  breast — 
say  from  one-half  to  three-quarters  of  an  hour — and 


THE  CHILD  43 

an  hour  after  feeding,  or  less,  seems  to  be  very  hungry. 
Fretting  and  crying  to  be  nursed  frequently  day  and 
night,  and  appearing  altogether  very  uncomfortable, 
it  ends  by  getting  the  reputation  of  being  a  very  cross 
baby.  In  this  condition  there  is  always  more  or  less 
colic  present,  frequently  constipation  or  diarrha^a, 
with  green  stools  containing,  mucus,  and  vomiting 
may  occur. 

Little  or  no  gain  in  weight  is  made,  and  not  in- 
frequently there  is  a  decided  loss,  and  the  child  looks 
pale  and  delicate. 

A  chemical  examination  of  the  mother's  milk  will 
determine  correctly  in  what  it  is  deficient,  and  then 
the  physician  will  be  able  to  treat  the  mother  intelli- 
gently so  that  the  quality  of  her  milk  may  be  im- 
proved. Milk  that  is  normal  should  be  of  a  bluish 
white  color,  and  upon  standing  for  twelve  hours  in 
a  bottle  or  narrow  glass  should  have  a  firm  layer  of 
cream  on  the  top. 

If  the  creams  forms  in  tiakes  it  is  a  sign  that  the 
milk  is  deficient  in  fat.  In  every  case  where  the 
child  is  not  thriving  there  should  be  special  treatment. 
The  mother  herself  can  do  much  to  improve  her  milk 
by  following  out  certain  rules.  She  should  try  to 
keep  herself  free  from  worry  and  care,  should  sleep 
at  least  eight  or  ten  hours  out  of  the  twenty-four, 
should  be  in  the  open  air,  if  possible,  for  three  or 
four  hours  each  day,  and  her  bowels  should  move 
once  daily.  The  diet  of  the  nursing  mother  should 
be  plain  but  substantial,  consisting  of  bread  and 
butter,  soup,  vegetables,  milk,  cream,  cereals,  stewed 


44  THE  CHILD 

and  ripe  fruits,  rare  lean  meats,  poultry,  fish,  cocoa, 
chocolate,  one  cup  of  coffee  daily,  and  plain  cake. 
Tea  and  all  highly  seasoned  and  rich  foods,  sauces, 
puddings,  pies,  should  be  avoided. 

It  must  be  remembered  that  a  sudden  fright,  great 
joy,  or  other  unusual  mental  impression,  will  often 
act  as  a  shock  to  the  mother,  and  so  affect  her  milk 
as  to  bring  on  an  attack  of  vomiting  or  diarrhoea  in 
the  child. 

It  is  a  wise  thing  to  begin  early  to  give  the  baby 
one  bottle-feeding  each  day  and  accustom  it  to  taking 
the  bottle.  This  will  allow  the  mother  greater  free- 
dom for  recreation,  permitting  her  to  visit  friends,  do 
shopping,  go  to  the  theater,  take  short  trips,  etc.,  and 
if  she  is  ill  the  baby  will  not  suffer. 

The  food  formula  used  should  correspond  to  the  age 
of  the  child,  as  designated  under  the  heading  of 
artificial  feeding.  From  one  to  two  bottle-feedings 
will  probably  be  necessary  by  the  seventh  month,  but 
should  the  milk  supply  fail  before  that  a  bottle-feeding 
may  be  given  every  third  or  every  second  feeding. 
So  long  as  the  child  may  be  nursed  to  advantage  it 
should  not  be  weaned,  but  if  it  is  found  that  the 
mother  cannot  give  the  breast  three  times  a  day,  then 
the  child  should  be  put  entirely  upon  the  bottle  and 
completely  weaned  from  the  breast. 

NURSING  FOR  TWENTY-FOUR  HOURS 

First  week    10  feedings 

First  week  to  fourth  week  9  feedings 

Fourth  week  to  tenth  week 8  to  9  feedings 


THE  CHILD  45 

Tenth  week  to  fourth  month   8  feedings 

Fourth  month  to  fifth  month 7  feedings 

Fifth  month  to  seventh  month  ....  6  to  7  feedings 
Seventh  month  to  ninth  month  ...  5  to  6  feedings 
Ninth  month  to  twelfth  month 5  to  6  feedings 


THE  WET-NURSE 

Where  other  methods  of  feeding  have  failed  a  wet- 
nurse  is  indispensable. 

In  the  selection  of  a  wet-nurse,  a  woman  between 
the  ages  of  twenty-one  and  thirty-five  should  be  chosen. 
The  peasant  women  of  Europe — German,  Austrian, 
or  Russo-Polish — make  the  best  wet-nurses.  Before 
the  wet-nurse  is  taken  into  the  family  she  should 
have  a  thorough  medical  examination  to  see  that  she 
is  free  from  all  skin  diseases,  tuberculosis,  syphilis, 
or  other  infectious  or  contagious  disease. 

One  of  the  best  indications  that  the  wet-nurse  has 
a  good  supply  of  milk  is  that  her  own  baby  is  well 
nourished.  It  is  not  necessary  that  the  age  of  the 
wet-nurse's  baby  be  the  same  as  that  of  the  patient 
for  whom  she  is  to  supply  milk ;  breast  milk  from  a 
month  to  three  months  will  be  right  for  any  infant. 

It  should  be  remembered  when  taking  a  wet-nurse 
that  she  has  left  her  own  baby  and  is  living  amid 
entirely  different  surroundings.  It  is,  therefore,  not 
surprising  if,  for  the  first  few  days,  her  milk  should 
cause  some  colic  or  slight  disagreement,  so  that  we 
should  not  be  too  quick  to  arrive  at  the  conclusion 
that  she  will  not  do  in  a  given  case.     The  wet-nurse 


46  THE  CHILD 

has  probably  been  used  to  a  simple  diet  and  plenty 
of  exercise,  so  she  should  be  given  plain  food,  such  as 
meat,  poultry,  vegetables,  cereals,  fish,  and  milk,  with 
one  cup  of  coffee,  and  not  more  than  two  cups  of 
tea,  daily.  Her  bowels  should  move  at  least  once  a  day. 
She  should  spend  three  or  four  hours  out-of-doors  each 
day,  and  during  the  time  that  she  is  not  busy  with  the 
baby  she  should  be  occupied  either  with  sewing  or  some 
light  housework.  The  baby  should  receive  one  bottle- 
feeding  each  day,  so  in  case  the  wet-nurse  is  ill  or 
suddenly  leaves,  the  child  will  not  suffer  until  another 
wet-nurse  can  be  procured. 

Usually  by  the  seventh  month  the  wet-nurse  can  be 
dispensed  with  and  the  baby  put  entirely  upon  the 
bottle,  except  in  the  summer,  when  it  might  be  wise 
to  retain  the  wet-nurse  somewhat  longer. 


WEANING 

When  it  has  been  decided  to  wean  the  child  the 
process  should  always  be  gradual,  when  this  is  possible, 
for  sudden  weaning  is  bad  for  both  mother  and  child, 
as  it  may  cause  an  acute  attack  of  indigestion  or 
diarrhoea. 

While  it  is  better  not  to  wean  the  child  during  the 
summer,  still  the  breast  nursing  should  not  be  unduly 
prolonged  on  this  account.  Many  women  among  the 
lower  classes  are  able  to  nurse  their  babies  up  to  the 
ninth  month,  and  some  can  do  so  to  the  twelfth  month 
with  advantage.    Among  the  more  fortunate  classes^ 


THE  CHILD  47 

however,  few  mothers  can  nurse  their  babies  beyond 
the  seventh  or  eighth  month,  while  still  a  smaller 
number  can  continue  to  do  so  beyond  the  ninth  or 
tenth  month  without  injury  to  both  mother  and  child. 
Before  the  sixth  or  seventh  month  the  best  guide  w^hen 
to  wean  is  the  child's  weight.  If  there  is  no  evident 
disease  and  the  weight  is  stationary  for  several  weeks, 
it  is  advisable  to  wean.  Where  there  is  a  steady  loss 
in  weight  weaning  is  absolutely  necessary. 

If  the  child  has  been  accustomed  to  take  one  or  two 
bottles  from  birth,  it  is  an  easy  matter  to  wean  by 
gradually  adding  one  more  bottle  each  day  in  place 
of  a  breast  feeding;  until  in  the  course  of  a  week  the 
baby  is  weaned  entirely  from  the  breast. 

In  case  of  any  acute  disease  of  a  serious  nature  in 
the  mother,  or  in  case  of  a  grave  chronic  disease,  the 
child  must  be  suddenly  weaned,  in  which  case  the  food 
given  should  be  much  weaker  than  that  ordinarily 
given  to  an  artificially-fed  infant  of  the  same  age. 
For  instance,  a  child  of  six  months  should  receive  the 
formula  proper  for  a  three-months  child,  or  a  child 
of  nine  months  that  ordinarily  given  to  a  six-months 
child.  After  the  baby  has  become  accustomed  to  the 
new  diet,  the  food  can  be  gradually  increased  in 
strength. 

SUBSTITUTE    FOR    BREAST    MILK— ARTIFICIAL 
FEEDING 

Every  yesit  thousands  of  infants  are  born,  who,  for 
some  reason,  cannot  have  the  advantage  of  breast- 


48  THE  CHILD 

feeding,  and  so  other  means  of  nourishment  must  be 
supplied.  Proprietary  foods  and  condensed  milk 
make  exceedingly  poor  substitutes  for  human  milk, 
and  unfortunately  a  wet-nurse  is  possible  to  but 
few.  In  selecting  a  milk  suitable  for  the  child  we 
must  be  guided  by  nature,  and  furnish  a  food  as 
nearly  as  possible  like  the  mother's  milk.  This  can 
be  accomplished  only  by  the  use  of  cow's  milk.  The 
average  good  cow's  milk  (from  a  mixed  herd)  contains 
approximately  4  per  cent  of  fat,  3.5  per  cent  of 
protein  (curd),  4  per  cent  of  sugar ;  while  human  milk 
contains  on  an  average  approximately  3.5  to  4.5  per 
cent  of  fat,  1.5  per  cent  of  protein,  and  6.5  to  7  per 
cent  of  sugar.  Thus  cow 's  milk  contains  more  protein 
and  less  sugar  than  mother's  milk. 

In  order  to  make  cow's  milk  simulate  as  closely 
as  possible  mother's  milk,  it  should  be  first  diluted 
with  water  to  decrease  the  percentage  of  protein,  and 
then  sugar  and  cream  should  be  added  to  increase  the 
sugar  and  fat  to  the  required  percentage.  This  proc- 
ess is  called  modifying.  The  ' '  modified  ' '  milk  must 
be  adapted  to  each  individual  child,  taking  into  con- 
sideration its  age  and  peculiarities.  One  child  may 
be  able  to  take  a  much  higher  percentage  of  protein, 
or  a  higher  percentage  of  fat,  or  more  milk  at  a  feed- 
ing, than  another  of  the  same  age,  and  may  require 
a  stronger  food  to  thrive.  It  should  be  remembered 
that  the  protein  of  cow's  milk  is  less  easily  digested 
than  mother's  milk,  as  it  forms  larger  and  tougher 
curds  in  the  stomach 

The  fat  of  cow's  milk  is  frequently  not  well  assimi- 


THE  CHILD  49 

lated  and  must  be  given  in  smaller  quantities  than 
is  present  in  mother's  milk.  The  mistake  is  often 
made  of  giving  the  milk  too  strong  at  first ;  this  causes 
vomiting,  diarrha?a,  or  constipation,  and  frequently 
colic. 

The  child  does  not  thrive,  and  it  is  argued  that  the 
milk  does  not  agree  with  it  and  that  some  food  other 
than  cow's  milk  should  be  used,  when  really  the  fault 
is  not  with  the  kind  of  milk  but  with  the  manner  in 
which  it  is  given. 

In  using  the  formulae  given,  it  should  be  understood 
that  they  are  suitable  for  the  average  child,  in  fair 
health,  but  of  course  it  would  be  impossible  to  give 
any  formulae  suited  to  every  case,  since  a  formula  that 
might  agree  perfectly  with  one  child  of  a  given  age 
might  not  be  adapted  at  all  to  another,  or  a  formula 
that  one  child  would  thrive  upon  might  be  too  strong 
or  too  weak  for  another  child  of  the  same  age.  We 
see  then  that  the  milk  food  has  to  be  adjusted  to  each 
individual  case,  not  only  in  quantity  but  also  as  to  the 
ingredients  of  which  it  is  composed.  Chemical  anal- 
ysis has  shown  that  the  upper  sixteen  ounces  of  a  quart 
bottle  of  good  milk,  after  standing  in  a  cool  place  for 
four  or  five  hours,  contains  about  7  per  cent  of  fat, 
3.2  per  cent  of  sugar,  and  3.2  per  cent  of  protein. 
Gravity  cream  contains  about  16  per  cent  of  fat.  We 
make  use  of  this  knowledge  to  modify  the  milk. 

The  physician  should  adapt  the  milk  to  the  digestion 
of  the  child.  Some  children  six  months  old  may  thrive 
on  a  milk  ordinarily  suitable  for  children  of  eight  or 
ten  months,  and,   on  the  other  hand,   children  six 


50  THE  CHILD 

months  old  may  require  milk  ordinarily  given  to  chil- 
dren three  or  four  months  of  age. 

There  are  occasionally  babies  who  cannot  take  cow's 
milk,  no  matter  how  modified.  In  such  cases,  the  child 
has  probably  been  badly  fed  from  the  beginning,  too 
strong  cow's  milk  having  been  given,  and  when  this 
was  found  to  disagree  some  one  of  the  proprietary 
foods  substituted.  Such  difficult  cases  require  the 
constant  care  and  watchfulness  of  both  physician  and 
mother.  Milk  for  a  time  must  be  stopped,  and  various 
substitutes  used,  such  as  whey,  barley-gruel,  broths, 
diluted  cream,  malt  soup,  one  of  the  malted  foods, 
or  condensed  milk.  After  a  time  one  feeding  of  much 
diluted  cow's  milk  may  be  substituted,  and  if  it  agrees 
the  number  and  strength  of  the  milk  feedings  can  be 
very  gradually  increased.  In  some  cases  the  digestive 
organs  are  so  hopelessly  upset  that  a  wet-nurse  is  the 
only  means  of  saving  the  child's  life. 

When,  on  account  of  low  power  of  protein  digestion 
in  the  child,  the  milk  is  given  very  much  diluted,  it 
may  be  of  advantage  to  add  a  half-tablespoonful  to  two 
tablespoonfuls  of  beef  juice  to  each  bottle  feeding, 
according  to  the  age  and  capacity  of  the  child. 

In  exceptional  cases  the  milk-sugar  is  not  well  borne, 
and  cane-sugar  or  maltose  may  have  to  be  used  in- 
stead; but  in  much  smaller  quantities,  on  account  of 
being  so  much  sweeter. 


THE  CHILD  51 

STERILIZATION  AND  PASTEURIZATION  OF  MILK 

Sterilized  milk  is  milk  that  is  heated  to  the  boiling 
point,  212°  F.,  and  kept  at  that  temperature  for  twenty 
minutes.  Pasteurized  milk  is  milk  that  is  heated  to  a 
temperature  of  140°  to  145°  P.,  and  kept  at  this  tem- 


Freeman  Pasteurizer. 

perature  for  twenty  minutes,  when  it  is  quickly  cooled 
by  placing  it  on  ice. 

Sterilization  destroys  all  pathogenic  bacteria,  but  it 
also  produces  a  peculiar  taste  and  destroys  certain 
nutritious  properties.  It  is  somewhat  less  easily  di- 
gested, and  frequently  causes  constipation  if  given  for 
a  long  period. 

Sterilized  milk  used  alone  continuously  for  a  long 
time  is  apt  to  produce  rickets,  or  scurvy.  Babies  tak- 
ing sterilized  milk  should  receive  orange  juice  daily 
to  prevent  these  diseases.  Among  the  poor  and  the 
ignorant  in  the  cities,  where  ice  is  not  available,  sterili- 
zation of  the  milk  is  advised  from  May  1st  to  October 
1st;  but  during  the  other  eight  months  of  the  year 
the  milk  should  be  given  raw.     In  some  infants  the 


52  THE  CHILD 

continued  use  of  sterilized  milk  will  cause  malnutrition 
and  stationary  weight. 

Pasteurization  interferes  less  than  sterilization  with 
the  nutritive  value  of  the  milk  and  at  the  same  time 
kills  most  of  the  pathogenic  bacteria;  it  is,  therefore, 
a  valuable  means  of  preserving  the  milk  during  hot 
weather,  has  not  the  disagreeable  effect  of  changing 
the  taste,  and  will  not  cause  constipation.  The  best 
method  of  pasteurizing  is  by  means  of  the  Freeman 
Pasteurizer.  If  for  any  reason  this  pasteurizer  cannot 
be  used,  the  milk  may  be  heated  over  a  slow  fire  in  a 
double  boiler  or  agate  basin,  to  the  desired  degree,  then 
poured  off  into  as  many  bottles  as  there  are  feedings — 
with  absorbent  cotton  placed  for  stoppers  in  each 
bottle — cooled  in  cold  water,  and  kept  in  a  cool  place, 
or  an  ice-box,  if  possible,  till  time  of  using. 

During  the  hot  months,  pasteurization  is  a  wise  pro- 
cedure, except  among  those  who  are  fortunate  enough 
to  live  near  their  source  of  milk  supply  and  know  that 
the  milk  is  perfectly  clean  and  can  be  obtained  before 
it  is  more  than  a  few  hours  old.  People  so  situated 
may  use  the  raw  milk  the  year  round  without  danger ; 
but  when  the  source  of  the  milk  is  not  known  and 
it  is  from  twenty  to  thirty-six  hours  old  before  reach- 
ing the  consumer,  it  will  be  better  pasteurized  unless 
the  high-priced  certified  milk  is  used. 


THE  CHILD  53 

THE  CARE  OF  BOTTLE  AND  NIPPLE 

There  is  a  great  variety  of  nui'sing-bottles  on  the 
market,  but  none  of  them  are  so  good  as  the  graduated, 
oval  bottle  of  eight  ounces  capacity. 

This  bottle,  on  account  of  its  rounded  corners,  is 
easily  kept  clean,  will  fit  in  the  ordinary  pasteurizer 


I i7., 


Nursing-Botlle  and  Nipple. 

or  sterilizer,  and,  if  broken,  is  easily  replaced.     As 
many  bottles  will  be  needed  as  there  are  feedings  in 
the  twenty-four  hours. 
Milk  bottles  are  best  cleansed  by  first  rinsing  with 


54  THE  CHILD 

cold  water  and  then  washing  with  hot  soapsuds  and 
a  bottle-brush,  care  being  taken  that  the  brush  is  al- 
ways clean.  Then  the  bottles  should  be  rinsed  in  an 
abundance  of  clean,  flowing  water,  and  examined  to 
see  that  no  cloudiness  or  speck  of  milk  remains.  After 
this  they  should  be  placed  in  a  rack  and  put  in  a 
moderately  hot  oven,  where  they  should  remain  for 
an  hour,  which  renders  them  sterile  and  again  ready 
for  use.  Before  removing  the  bottles  the  oven  door 
should  be  opened  for  a  short  time,  so  that  they  will 
not  crack  from  the  sudden  change  of  temperature. 

Another  method  is  to  place  the  bottles  over  the  fire 
in  a  boiler  of  cold  water,  and  allow  them  to  boil  for 
half-an-hour,  when  they  should  be  carefully  drained 
and  kept  from  all  dust.  The  first  of  these  two  methods 
will  be  found  preferable. 

After  the  baby  has  been  fed  the  empty  or  partially 
emptied  bottle  should  not  be  allowed  to  stand,  but 
should  be  emptied  directly  and  rinsed  with  cold  water, 
and  later  the  entire  number  of  bottles  washed  again, 
as  already  described.  Under  no  circumstances  should 
a  warmed-over  bottle  of  milk  be  given. 

The  nipples  should  be  of  the  plain  black  seamless 
variety,  rather  small  in  size,  as  these  do  not  collapse 
and  can  be  easily  turned  inside  out  and  thoroughly 
cleaned  with  a  brush.  One-half  dozen  should  be  kept 
on  hand.  Each  nipple  should  be  boiled  once  a  day 
and  dipped  in  boiling  water  just  before  using.  After 
the  nipples  are  cleansed  they  should  be  kept  in  a  cov- 
ered jar  or  box,  or  wrapped  in  a  clean  linen  cloth. 


THE  CHILD  55 

MILK  MODIFICATION 

The  following  milk  formulae  will  be  found  suitable 
for  the  majority  of  healthy  infants ;  where  these  modi- 
fications do  not  agree  with  the  child  the  milk  should 
be  especially  adapted  to  its  individual  digestion. 

One  quart  bottle  of  milk  is  needed  each  day  for  the 
first  five  months ;  after  that  time  two  one-quart  bottles 
will  be  required. 

It  is  of  great  importance  that  a  good  milk  be  pur- 
chased, and  I  always  advise  one  of  the  brands  certified 
by  the  New  York  Milk  Commission,  when  it  is  obtain- 
able. For  those  living  in  the  suburban  towns,  in  the 
country,  or  in  other  states,  where  certified  milk  is  not 
obtainable,  the  cleanest  and  freshest  milk  that  can 
be  had  should  be  used.  Those  who  are  fortunate 
enough  to  have  cows  will,  of  course,  use  milk  from 
their  own  herd.  Rules  regarding  cleanliness,  imme- 
diate rapid  cooling,  and  icing  of  the  milk  we  find 
obtain  in  creameries  and  lurge  dairies  which  supply 
the  city.  Many  people  in  the  smaller  interior  villages 
are  obliged  to  get  their  milk  from  farmers  whose 
dairies  are  not  under  rigid  inspection.  These  dairies 
may  have  tuberculous  cows,  the  dairymen  may  be  care- 
less and  uncleanly  about  the  milking,  the  milk  may 
not  be  cooled  immediately,  and  the  dairymen  may 
not  have  the  facilities  or  ice  for  keeping  it  cool  until 
it  reaches  the  consumer,  consequently  germs  may  mul- 
tiply rapidly.  Such  milk  is  fraught  with  danger,  and, 
in  many  cases,  with  disastrous  results  to  the  baby 
using  it.     People  who  are  not  sure  of  the  cleanliness 


56  THE  CHILD 

of  their  milk  supply  would  do  well  to  inspect  and 
investigate  personally  its  source.  If  it  is  found  that 
cleanliness,  sanitation,  cooling,  and  icing  are  not  care- 
fully observed,  it  would  be  well  to  seek  a  reliable  milk 
supply  nearer  home,  where  the  milk 
/^^  can  be  delivered  to  the  consumer  more 
promptly,  and,  also,  properly  iced.  When 
it  is  impossible  to  secure  milk  iced  before 
delivery,  it  is  advisable  to  pasteurize  the 
milk  during  the  summer  months — for  in- 
stance, from  May  1st  to  October  1st. 

In  the  modification  of  milk  from  one 
cow,  used  for  infant  feeding,  it  should  be 
remembered  that  the  milk  from  a  Jersey 
is  much  richer  in  butter  fat  than  the  milk 
from  other  breeds,  or  from  a  mixed  dairy. 
Most  Jersey  milk  contains  from  five  to  ^ye 
,  and  a  half  per  cent  of  fat,  and  the  gravity 

DiDDer        cream  from  such  milk  contains  twenty  to 
twenty-two  per  cent  of  fat,  so  that  allow- 
ance must  be  made  for  this  fact  by  greater  dilution 
in  the  modification  of  the  milk. 

As  a  rule,  the  most  expensive  milk  will  be  found 
the  best  and  cheapest  in  the  end,  and  the  mixed 
milk  from  a  herd  of  graded  cows  is  preferable  to 
that  from  one  cow. 

As  soon  as  the  milk  is  delivered,  which  is  usually 
about  six  or  seven  o'clock,  it  should  be  placed  in  the 
ice-chest  and  allowed  to  stand  for  four  or  ^ve  hours ; 
by  that  time  the  cream  will  have  risen.  The  milk  is 
then  ready  to  be  modified.     Prom  the  quart  bottle  of 


THE  CHILD 


57 


milk  dip  off  the  upper  half,  or  sixteen  ounces,  into  a 
cream  bowl,  using  a  Chapin  dipper;  from  this  **top 
milk  ''  the  required  number  of  ounces  are  taken  for 
each  formula. 

After  the  fifth  month  it  will  be  necessary  to  mix 
the  upper  half  of  two  bottles,  and  from  the  seventh 


<Jgp^          'W 

V — ^~^ 

-_-j6fl 

«H 

^1^ 
^ 

ZMa 

jyyKfciiii> 

iliuttltii 


Pint  Graduate  Measure. 


to  the  twelfth  month  the  upper  twenty  ounces  are  used 
in  order  to  obtain  the  required  number  of  ounces  of 
top  milk. 

The  milk-sugar  should  be  dissolved  in  hot  water  be- 
fore adding  to  the  milk.  The  cream  at  the  top  of  the 
bottle  is  known  as  gravity  cream. 

The  upper  portion  of  the  cream  in  the  bottle  is 
richer  in  fat  than  that  which  is  nearer  the  milk,  and 


58  THE  CHILD 

for  that  reason,  in  order  to  obtain  a  uniform  strength 
of  fat,  all  the  cream  should  be  dipped  from  the  bottle 
and  placed  in  a  pint  graduate  or  cream  bowl,  where 
it  is  thoroughly  mixed  before  using  to  modify  the 
milk. 

TOP  MILK  FORMULA 

First  Week 

One  quart  bottle  of  milk  needed,  of  this  the  upper  16 
oz.  are  mixed.     Of  this  ^^  top  milk  "  take : 

APPROXIMATE 
rn                 -li  01/  PERCENTAGE 

lop  milk 272  oz.  EQUIVALENT 

Lime-water V2  Fat 1.1 

Milk-sugar    1  Sugar    ...   6.7 

Boiled  or  filtered  water  to  make  15  Protein    . .     .5 

10  feedings  in  24  hours,  1  to  iy2  oz.  at  each  feeding;  2 
night  feedings,  10  p.m.  and  7  a.m. 

2  level  tablespoonfuls  granulated  sugar  equals  1  oz. 

3  level  tablespoonfuls  of  milk-sugar  equals  1  oz. 

From  Eighth  Day  to  Fourth  Week 

The  upper  16  oz.  of  a  quart  bottle  are  mixed,  and  of  this 
"  top  milk  "  take : 

APPROXIMATE 
PERCENTAGE 

Top  muk 8  oz.  equivalent 

Lime-water 2  Fat    1.86 

Milk-sugar     1%  Sugar    .  .   6.9 

Water  to  make  30  Protein    .     .85 


THE  CHILD  59 

9  to  10  feedings  in  24  hours,  2  to  3  oz.  at  each  feeding; 
2  night  feedings,  10  p.m.  and  7  a.m. 

From  Fourth  to  Tenth  Week 

The  upper  16  oz.  of  a  quart  bottle  are  mixed,  and  of  this 
"  top  milk  "  take : 

APPROXIMATE 
^       ...  ^^  PERCENTAGE 

lop  milk 11  oz.       EQUIVALENT 

Lime-water    2  Fat    2.4 

Milk-sugar    2  Sugar    ...  7.1 

Water  to  make 32  Protein    . .   1.1 

8  to  9  feedings  in  24  hoUi*s,  feed  evexy  2V^  hours;  2V^  to 
3V2  oz.  at  a  feeding;  1  night  feeding. 

From  Tenth  Week  to  the  Fourth  Month 

The  upi)er  IG  oz.  of  a  quart  bottle  are  mixed,  and  of  this 
''  top  milk  ''  is  taken  : 

APPROXIMATE 

PEKCKNTAJJK 

lop    nulk     1.5  oz.  EQUIVALENT 

Lime-water    ;}  Fat    2.8 

Milk-sugar 1%        Sugar    ...   G.8 

Water  to  make 32  Protein    . .   1.3 

7  to  8  feedings  in  24  hours  of  3  to  4V2  oz-  each,*  feed 
every  2^/2  to  3  hours;  1  night  feeding. 

From  Fourth  to  Fifth  Month 

The  upper  17  oz.  of  a  quart  bottle  are  mixed,  and  of  this 
"  top  milk  "  is  taken  : 

*  If  4^  oz.  are  given  at  a  feeding,  14  oz.  of  top  milk,  2  oz.  of 
milk  sugar,  3  oz.  of  lime  water,  and  water  to  make  36  oz.  should 
be  used. 


60  THE  CHILD 

APPROXIMATE 
rjy  -ii  /  -,  rr  PERCENTAGE 

Top  milk  . .  ,^y .,,.  /.< 17  oz.  equivalent 

Lime-water    4  Fat    3.0 

Milk-sugar     2  Sugar    ...   6.9 

Water  to  make 38  Protein    . .  1.4 


7  feedings  in  24  hours,  feed  4:V2  to  5  oz.  every  3  hours: 
1  night  feeding. 

From  the  Fifth  to  the  Seventh  Month 

Two  one-quart  bottles  will  be  needed.     16  oz.  of  "  top 
milk  "  are  removed  from  each  bottle  and  mixed. 

APPROXIMATE 
PERCENTAGE 

lop  milk 23  oz.  equivalent 

Lime-water    4  Fat    3.8 

Milk-sugar 2  Sugar    . .  6.8 

Water  to  make 42  Protein    .   1.75 

6  to  7  feedings  in  24  hours,  6  to  7  oz.  every  3  to  3y3  hours; 
no  night  feeding. 

From  the  Seventh  to  the  Ninth  Month 

Two  one-quart  bottles  of  milk  needed.     Top  20  oz.  from 
each,  mix,  and  take  of  this  "  top  milk  " : 

APPROXIMATE 
PERCENTAGE 

Top  milk 30  oz.  equivalent 

Lime-water    5  Fat    ....  3.7 

Milk-sugar     2^/4  Sugar    . .  7. 

Water  to  make 48  Protein    .   2.25 

5  to  6  feedings  in  24  hours,  6  to  8  oz.  at  a  feeding,  feed 
every  3y2  hours;  no  night  feedings. 


THE  CHILD  61 

From  the  Ninth  to  the  Twelfth  Month 

Two  one-quart  bottles  of  milk  needed.  Take  top  20  oz. 
of  each  and  mix ;  of  this  "  top  milk  "  is  taken : 

APPROXIMATE 
PERCENTAGE 

iop  milk do  oz.  equivalent 

Lime-water    5  Fat    4. 

Milk-sugar 2V2  Sugar    ...  7. 

Water  to  make 54  Protein    . .  2.4 

Feed  every  4  hours,  5  to  6  feedings  in  24  hours,  8  to  9  oz. 
at  a  feeding;  no  night  feeding. 

In  certain  cases  it  maiy  be  desirable  to  give  a  milk 
formula  with  a  lower  percentage  of  fat  and  higher 
percentage  of  protein  than  is  present  in  the  top  milk 
formula.  This  is  done  by  using  whole  milk  or  top, 
and  skimmed  in  place  of  the  top  milk  alone,  as  is 
shown  in  the  following  formula\  It  has  been  found 
that  skimmed,  or  bottom  milk,  contains  about  1  per 
cent  of  fat,  3.5  per  cent  of  sugar,  and  3  per  cent  of 
protein. 

Some  babies  thrive  better  on  a  higher  percentage  of 
protein  or  a  lower  percentage  of  fat  in  their  food, 
while  others  seem  to  do  better  on  the  lower  protein 
and  higher  fat  diet  as  found  in  the  top  milk  mixtures. 
So  that  we  find  that  regulating  the  amount  of  food 
and  adapting  the  strength  of  its  different  ingredients 
to  the  digestive  capacity  of  the  individual  case  con- 
stitutes the  art  of  infant  feeding  and  tests  the  skill 
and  experience  of  the  physician. 

The  following  formulae,  made  up  from  the  whole 
milk,  may  be  found  useful  for  babies  from  the  fifth 


62  THE  CHILD 

to  the  twelfth  month  who  have  poor  fat  digestion, 
especially  during  the  summer,  when  fat  is  not  so  well 
digested. 

WHOLE  MILK  FORMULA 
From  Fifth  to  Seventh  Month 
One  quart  bottle  of  milk  should  be  mixed.     Of  this  take: 

APPROXIMATE 
xxrv,    ^  -n  o^  PERCENTAGE 

Whole  milk 26  oz.  equivalent 

Lime-water    4  Fat    ....   2.47 

Milk-sugar 2  Sugar    . .   7. 

Water  to  make 42  Protein    .   2.16 

6  to  7  feedings  in  24  hours,  6  to  7  oz.  every  3  to  SVa  hours; 
no  night  feedings. 

From  the  Seventh  to  the  Ninth  Month 
One  quart  bottle  of  milk. 

APPROXIMATE 
XXT\^    1     -n  on  PERCENTAGE 

Whole  milk 32  oz.  equivalent 

Lime-water    5  Fat    ....  2.66 

Milk-sugar 2*A  Sugar    . .  7. 

Water  to  make   48  Protein    .  2.3 

5  to  6  feedings  in  24  hours,  6  to  8  oz.  at  a  feeding,  feed 
every  3V^  hours;  no  night  feeding. 

From  the  Ninth  to  the  Twelfth  Month 
Two  one-quart  bottles  of  milk  needed,  mix  and  take : 

APPROXIMATE 
PERCENTAGE 

Whole  milk 40  oz.  equivalent 

Lime-water    5  Fat    3. 

Milk-sugar 2^/4         Sugar    .  . .   6.8 

Water  to  make   54  Protein    . .  2.6 

Feed  every  4  hours,  5  to  6  feedings  in  24  hours.    8  to  9 
oz.  at  a  feeding;  no  night  feeding. 


THE  CHILD  63 

Barley  gruel,  used  as  a  diluent  in  place  of  plain 
water,  breaks  up  the  curd,  and  the  proteins  of  the  gruel 
are  often  more  easily  digested  by  babies  than  the  pro- 
teins of  cow's  milk.  The  use  of  barley  gruel  is  a  con- 
venient means  of  reinforcing  a  modified  milk  formula 
that  is  deficient  in  protein.  Two  level  tablespoon fuls 
of  barley  gruel,  or  oatmeal  gruel  flour,  to  the  quart  of 
water  contains  approximately  .24  per  cent  protein 
and  1.20  per  cent  carbohydrates.  By  increasing  the 
strength  of  the  gruel  the  percentage  of  protein  and 
carbohydrate  may  be  proportionately  increased. 

The  Cereo  Company  of  Tappan,  New  York,  make 
an  excellent  barley  and  oatmeal  flour.  Robinson's 
patent  barley  flour  is  also  much  in  use.  These  gruel 
flours  are  much  to  be  preferred  to  the  unground  grain. 

THE  DEMING  PERCENTAGE  MILK  MODIFIER 

This  is  a  sixteen-ounce  graduate  adapted  for  work- 
ing directly  with  percentages  in  the  home  modification 
of  cow's  milk  for  infant  feeding.  The  graduate  has 
a  column  of  figures  in  red  which  represent  the  per- 
centages of  protein,  and  several  other  columns  which 
represent  the  percentages  of  fat.  The  fat  percentages 
are  obtained  in  the  different  columns  by  using  four 
per  cent  milk  (whole  milk),  seven  per  cent  milk  (the 
top  sixteen  ounces  of  a  quart),  twelve  per  cent  (or 
the  top  nine  ounces  of  one  quart). 

For  four  per  cent  milk  shake  the  bottle  to  mix 
the  cream  and  milk.  To  obtain  fat-free  milk  dip  off 
the  cream  and  use  the  remaining  skim  milk. 


64 


THE  CHILD 


Th€  desired  percentage  of  protein  is  found  in  the 
column  headed  protein;  we  follow  this  line  to  the 
right  until  the  desired  percentage  of  fat  is  found; 
at  the  head  of  this  fat  column  the  strength  of  the  milk 
to  be  used  is  indicated.     This  milk  is  poured  into  the 


The  Deming  Milk  Modifier. 


modifier  up  to  the  desired  percentage  of  protein,  and 
water  or  other  diluents  added  to  the  top  line,  making 
sixteen  ounces. 

The  percentage  of  sugar  is  the  same  as  that  of 
the  protein,  and  for  every  level  tablespoonful  of  gran- 
ulated sugar  or  one  and  a  half  level  tablespoonfuls  of 
milk-sugar  the  percentage  of  sugar  in  the  mixture  will 


THE  CHILD  65 

be  increased  two  and  a  half  (2^)  per  cent.  The 
**  Chapin  Dipper/'  containing  one  ounce,  is  necessary 
to  dip  off  the  top  milk  from  a  quart  bottle. 


Knitted  Bag  for  Bottle.  In-a-Wink  Heater. 

The  milk  modifier  is  very  convenient  for  home  modi- 
fication of  milk  when  used  under  the  proper  guidance 
of  the  physician. 

HOW  TO  HOLD  THE  BABY  WHEN  NURSING  THE 
BOTTLE 

When  the  bottle  is  given,  the  baby  should  be  held 
in  the  lap  of  the  mother  or  nurse,  the  head  and  body 
slightly  raised  to  a  semi-sitting  posture.  The  attend- 
ant should  hold  the  child  with  its  head  on  her  right 
arm,  her  left  hand  being  free  to  hold  the  bottle  up 
so  that  air  is  not  sucked  instead  of  milk. 

The  bottle  should  be  encased  in  a  knitted  or  flannel 
bag  to  retain  the  heat  while  the  child  nurses. 


66  THE  CHILD 

The  Walker-Gordon  ''  In-a-Wink  "  milk-warmer, 
with  an  alcohol  or  gas  flame,  is  a  convenient  little 
heater  to  use  for  warming  a  single  bottle,  especially 
for  the  night  feeding. 


Way  to  Hold  the  Baby  when  Nursiug  the  Bottle. 

HOW    TO    HOLD   A   BABY   WHEN   NURSING   THE 
BREAST 

When  nursing  the  breast  the  baby  should  be  held 
in  the  mother 's  lap,  and  her  knee  on  the  side  that  the 


THE  CHILD  67 

baby  is  nursing  should  he  slightly  raised;  with  the 
thumb  and  forefinger  of  the  hand  on  the  same  side 


Way  to  Hold  the  Baby  when  Nursing  the  Breast. 

she  should  grasp  the  breast  and  draw  it  forward,  while 
with  the  other  hand  she  should  hold  the  baby^s  head 
to  the  breast. 

SIGNS  OF  SUCCESSFUL  ARTIFICIAL  FEEDING 

The  signs  of  successful  bottle-feeding  are  a  steady 
gain  in  weight  of  from  four  to  eight  ounces  a  week; 


68  THE  CHILD 

two  or  three  yellow  stools  dpily ;  peaceful,  quiet  sleep ; 
and  the  bottle  taken  at  the  regular  intervals  greedily. 
In  other  words,  comfort  and  happiness. 

The  signs  of  unsuccessful  feeding  are  loss  in  weight 
or  very  slight  gain,  vomiting,  undigested  green  stools, 
discomfort  after  feeding,,  colic,  restlessness,  peevish- 
ness, and  wakeful  nights. 


SIGNS  OF  SUCCESSFUL  BREAST  FEEDING 

The  signs  of  successful  breast  feeding  are  an  average 
gain  of  five  to  eight  ounces  a  week,  two  or  three  yellow 
stools  a  day,  quiet  sleep,  absence  of  colic  or  vomiting, 
hunger  at  the  regular  feeding  intervals — which  hunger 
is  satisfied  after  nursing  for  fifteen  minutes  at  the 
breast  until  the  next  feeding  period. 

The  signs  of  unsuccessful  breast  feeding  are  loss 
or  very  slight  gain  in  weight,  a  tendency  to  remain 
long  at  the  breast,  and  half  an  l^our  afterward  to 
be  peevish,  crying,  and  seeming  hungry ;  to  sleep 
badly,  and  to  have  green  stools,  vomiting  and  indiges- 
tion, with  colic. 


PEPTONIZED  MILK 

Peptonized  milk,  although  now  rarely  used,  is  no 
doubt  of  benefit  in  certain  cases  where  the  curd  of 
even  properly  modified  cow's  milk  cannot  be  di- 
gested. 

In  acute  or  chronic  illness,  where  food  cannot  be 


THE  CHILD  69 

taken  by  the  natural  method  on  account  of  sore  throat 
or  paralysis  of  the  throat,  peptonized  milk  can  be  given 
through  the  stomach  tube. 

When  stomach  feeding  is  impossible  on  account  of 
vomiting,  or  for  any  other  reason  a  nutrient  enema  of 
peptonized  milk  may  be  given  through  the  bowel. 

The  usual  method  of  peptonizing  milk  is  to  add 
from  one-eighth  to  one-quarter  of  the  contents  of  a 
Fairchild  peptonizing  tube  to  the  milk  mixture  in  the 
nursing  bottle ;  this  is  placed  in  water  at  a  temperature 
of  110°  F.  to  120°  F.  for  fifteen  minutes. 


CONDENSED  MILK 

No  infant  should  ever  be  fed  upon  condensed  milk 
alone  for  a  long  period,  since,  on  account  of  the  low 
nutritional  value  of  the  milk,  sooner  or  later  either 
the  child's  weight  will  remain  stationary  or  symptoms 
of  rickets  or  scurvy  will  develop. 

The  natural  food  is  the  mother's  milk,  which  anal- 
ysis shows  to  contain  approximately  3.5  per  cent  to 
4  per  cent  of  fat,  1.5  per  cent  of  protein,  and  7  per 
cent  of  sugar. 

In  order  to  prepare  condensed  milk  for  feeding  it 
should  be  diluted  ten  or  twelve  times,  or  even  more, 
for  infants  under  three  months  of  age,  and  five  or  six 
times  for  those  six  months  and  older.  Diluting  con- 
densed milk  twelve  times  with  water  would  make  a 
solution  containing  approximately  .7  per  cent  of  fat, 
,8  per  cent  of  protein,  and  4.2  per  cent  of  sugar. 


70  THE  CHILD 

Comparing  this  with  mother's  milk,  we  see  it  is  very 
deficient  in  fat,  and  also,  to  a  less  degree,  in  protein. 

Condensed  milk  is  useful,  however,  in  convalescence 
from  diarrhoea,  and  in  cases  of  very  weak  digestion. 

For  traveling,  condensed  milk  is  convenient,  as  it 
is  easily  prepared.  Condensed  milk  is  sometimes  used 
to  advantage  among  the  poor  and  ignorant,  especially 
during  hot  weather  when  ice  cannot  be  obtained,  since 
the  milk  keeps  well  and  is  quickly  mixed. 

If  condensed  milk  is  given  for  more  than  one  or 
two  weeks,  top  milk  or  cream  should  be  added  to  give 
a  greater  percentage  of  fat. 

For  children  over  three  months  old  barley  gruel 
should  be  used  as  a  diluent  in  place  of  water. 

The  following  dilutions,  as  given  by  Dr.  Kerley, 
are  most  suitable  for  the  various  ages. 

Under  Three  Months  of  Age. — Condensed  milk, 
one-half  to  one  teaspoonf ul ;  water,  two  to  four  ounces. 

Third  to  Sixth  Month. — Condensed  milk,  one  to 
two  level  teaspoonf uls ;  barley-water,  four  to  six 
ounces. 

Sixth  to  Ninth  Month. — Condensed  milk,  three 
teaspoonf  uls ;  barley-water,  eight  ounces. 

The  sweetened  variety  of  condensed  milk  is  always 
preferable  as  it  keeps  best,  while  the  unsweetened  soon 
becomes  rancid  after  the  can  is  opened.  When  con- 
densed milk  is  used  a  teaspoonful  of  orange  juice 
should  be  given  three  times  a  day. 


THE  CHILD  71 

PROPRIETARY  FOODS 

Proprietary  foods  should  never  be  given  to  healthy- 
babies.  The  only  time  when  it  may  be  permissible 
to  use  them  is  occasionally  in  cases  of  illness,  as  most 
of  them  are  easy  of  digestion.  They  have  very  little 
nutritional  value  as  compared  with  mother's  milk  or 
modified  cow's  milk.  All  of  them  are  very  deficient 
in  animal  fat  and  animal  protein.  ]\Iost  of  them  con- 
tain a  high  percentage  of  sugar,  so,  when  added  to 
cream,  milk,  and  water,  they  simply  take  the  place 
of  the  sugar  in  the  modified  milk,  the  other  nutritive 
elements  being  supplied  from  the  cream  and  milk. 
When  these  foods  are  given,  mixed  only  with  water, 
they  invariably  produce,  if  taken  for  any  length  of 
time,  either  rickets  or  scurvy.  They  should,  therefore, 
never  be  used  except  under  a  physician's  directions, 
and  only  until  a  more  substantial  food  can  be  digested. 


DIET  DURING  ILLNESS 

Even  slight  illness  in  infants  and  young  children 
diminishes  the  power  of  digestion.  On  this  account  the 
food  given  them  should  be  diminished  in  strength 
according  to  the  severity  of  the  illness. 

If  a  nursing  baby  is  taken  ill,  plenty  of  water  should 
be  given  before  each  nursing,  and  the  baby  should  be 
allowed  only  half  the  accustomed  time  at  the  breast. 
In  case  the  patient  is  a  bottle  baby,  half  the  con- 
tents of  the  bottle  should  be  poured  out  and  the  same 


72. 


THE  CHILD 


amount  of  boiled  water  added  before  giving  it  to  the 
child.  "Where  the  illness  is  less  severe  the  dilution 
may  be  less.  At  the  first  symptom  of  summer  diar- 
rhoea all  milk  must  be  stopped  at  once,  and  the  child 
fed  as  directed  under  the  heading  of  diarrhoea. 

Older  children  may  be  given  broths  and  cereal 
gruels  during  a  severe  illness,  together  with  all  the 
water  they  want  to  drink. 

MILK  FOR  TRAVELING 


Ice-Box  for  Traveling. 

When  taking  a  journey  it  is  essential  that  the  baby's 
food  should  be  as  nearly  as  possible  the  same  as  that 


THE  CHILD  73 

to  which  it  is  accustomed.  In  order  to  secure  this 
result  the  milk  must  be  kept  on  ice. 

The  Walker-Gordon  Company  furnishes  small  ice- 
boxes which  have  room  for  a  four  days'  supply. 
These  boxes  can  be  easily  carried  on  boats  or  cars 
and  kept  supplied  with  ice  by  the  porter.  In  making 
an  ocean  voyage  still  larger  boxes  may  be  supplied. 
These  will  hold  a  dozen  quart  bottles  of  milk,  and 
may  be  kept  in  the  cold-storage  room. 

Those  who  are  unable  to  avail  themselves  of  the 
ice-boxes  may  substitute  condensed  milk  as  indicated 
in  the  formula?  in  place  of  the  fresh  cow's  milk. 


DIET  FROM  THE  FIRST  TO  THE   SIXTH  YEARS 

After  the  first  year,  whole  milk  may  usually  be 
given,  and  a  more  extended  and  varied  diet  is  de- 
sirable, and,  indeed,  necessary  for  proper  growth  and 
development.  The  following  diet  schedules  will  be 
found  appropriate  for  the  needs  of  the  growing  child. 


FIRST  YEAR  TO  THE  EIGHTEENTH  MONTH 

First  Meal,  7  to  7.30  a.m. — One  or  two  tablespoon- 
fuls  of  barley,  wheat,  or  oatmeal  gruel  in  half  a  pint 
of  milk.  (The  gruels  are  made  by  cooking  the  cereal 
for  three  hours  and  then  straining.)  Gruel  may  be 
alternated  with  zwieback  or  stale  toasted  bread. 

9  a.m. — The  juice  of  an  orange  or  the  pulp  of  three 


74  THE  CHILD 

to  six  stewed  prunes  may  be  given  or  half  of  a  scraped, 
ripe  apple. 

Second  Meal,  11  a.m. — One  or  two  teaspoonfuls, 
or  a  tablespoonful,  of  scraped  rare  beef,  or  two  or 
three  ounces  of  beef  juice,  or  a  soft-boiled  egg  mixed 
with  dry  bread  crumbs,  a  half-pint  of  milk,  a  bran 
biscuit,  a  crust  of  bread  or  slice  of  toasted  bread. 

Third  Meal,  2  to  3  p.m. — Mutton,  chicken,  or  beef 
broth,  with  dry  bread  crumbs  mixed  with  it,  and  a 
large  glass  of  milk.  After  the  fifteenth  month  plain 
desserts  may  be  given  at  this  meal,  such  as  custard, 
corn-starch,  rice-pudding  (without  raisins),  baked 
apples,  or  apple  sauce,  or  the  pulp  of  stewed  prunes. 
A  flour  made  from  peas,  beans,  and  lentils  by  the 
Cereo  Company,  and  called  ''  Legume  Flour  "  makes 
a  most  excellent  and  nourishing  soup,  and  may  be 
used  alternately  or  in  place  of  broths. 

Fourth  Meal,  5.30  to  6.30  p.m.— After  the  fifteenth 
month  this  meal  should  be  made  up  of  from  one  to 
three  tablespoonfuls  of  cereal  gruel,  as  farina,  oat- 
meal, or  barley,  in  eight  ounces  of  milk,  and  a  table- 
spoonful  of  apple  sauce.  Before  the  fifteenth  month 
the  child  will  probably  require  a  milk  feeding  at 
10  P.M. 

DIET  FROM  THE  EIGHTEENTH  MONTH  TO  THE 
SECOND  YEAR 

BrExVkfast,  7  to  7.30  a.m. — One  of  the  cereals,  such 
as  oatmeal,  hominy,  farina,  or  cream  of  wheat,  given 
with  milk  and  cream,  a  soft-boiled  egg,  or  a  lamb  chop 


THE  CHILD  75 

finely  cut,  a  glass  of  milk,  dry  toast,  or  stale  bread 
and  butter.  ^ 

9  A.M. — A  small  amount  of  scraped  raw  apple  or 
the  juice  of  an  orange,  and  one  graham  cracker,  or 
some  zwieback. 

11  A.M. — The  lean  from  rare  beefsteak  or  roast-beef 
either  scraped  or  finely  cut,  or  beef  juice  with  stale 
bread  crumbs,  spinach,  asparagus  tips,  baked  apple, 
or  apple-sauce,  a  piece  of  bread  and  butter,  and  a 
glass  of  milk. 

After  the  nineteenth  or  twentieth  month,  baked 
potatoes,  with  salt  and  butter,  or  cream,  mashed  string- 
beans,  or  new  peas,  carefully  mashed,  may  be  given 
in  small  quantities. 

2.30  to  3  P.M. — A  cupful  of  beef,  chicken,  or  mutton 
broth  with  dry  bread  crumbs  broken  into  it  or  thick- 
ened with  peas,  farina,  or  rice,  or  four  to  six  ounces 
of  Legume  soup,  a  piece  of  brown  or  white  bread 
and  butter,  a  glass  of  milk,  stewed  prunes,  apple-sauce, 
or  plain  rice-pudding. 

6  P.M. — Bread  and  milk,  rice  and  milk,  hominy  and 
milk,  farina  and  milk,  or  cream  of  wheat  and  milk. 

THE  DIET  FOR  A  CHILD  OF  FROM  TWO  TO  SIX  YEARS 
OF  AGE 

After  the  second  year  the  diet  may  be  considerably 
expanded,  and  the  mother  will  be  able  to  choose  a 
more  varied  bill  of  fare. 

Breakfast,  7  to  7.30  a.m. — The  juice  of  an  orange, 
or  a  baked  apple,  oatmeal  gruel,  farina,  hominy,  cream 


76  THE  CHILD 

of  whieat,  rolled  wheat  porridge  with  cream,  and  a 
small  amount  of  sugar  (if  desired),  a  soft-boiled  egg, 
poached,  or  coddled  egg,  bread  and  butter,  a  lamb 
chop,  or  a  small  piece  of  finely  cut  rare  beefsteak,  a 
glass  of  milk,  a  small  piece  of  toast,  some  tapioca,  or 
stewed  rhubarb. 

JO  A.M. — A  graham  cracker  and  a  glass  of  milk,  or 
the  pulp  of  six  stewed  prunes. 

Dinner,  12  to  1  p.m. — Chicken,  beef,  or  mutton 
broth,  a  small  piece  of  rare  roast  beef  or  steak,  broiled 
or  stewed  chicken  (white  meat),  baked,  broiled,  or 
boiled  fish,  new  string  beans  or  peas,  spinach,  aspar- 
agus tips,  boiled  creamed  white  onions,  and  boiled 
new  carrots,  macaroni  boiled  in  salt  water,  or  spaghetti 
(these  two  articles  are  especially  good  in  summer  to 
take  the  place  of  meat),  creamed  celery,  puree  of 
stewed  com,  or  corn  that  has  been  boiled  on  the  cob 
scored  and  pressed  out  with  the  knife,  and  bread  and 
butter,  and  a  glass  of  milk. 

For  desserts  the  following  may  be  given:  Orange, 
lemon,  or  calf's  foot  jelly  (made  with  gelatine),  baked 
apple,  apple-sauce,  cornstarch,  custard,  bread-pudding 
or  rice-pudding  without  raisins,  crabapple,  quince,  or 
raspberry  jelly  spread  on  bread,  tapioca  pudding, 
blanc-mange. 

3  P.M. — A  glass  of  milk  and  a  graham  cracker,  if 
the  child  feels  hungry  and  seems  to  require  it. 

Supper,  5  to  6  p.m. — Bread  and  milk,  graham 
crackers  and  milk,  farina  and  milk,  cream  of  wheat 
and  milk,  hominy  and  milk,  rice  and  milk,  thick  pea 
soup  or  cream  of  celery,  or  Legume  soup,  bread  and 


THE  CHILD  77 

butter,  plain  or  spread  with  a  little  currant,  raspberry, 
crabapple,  or  quince  jelly;  a  little  plain  ice-cream  or 
custard  may  be  given  once  or  twice  each  week. 


RECIPES 

Beef,  Mutton,  and  Chicken  Broth. — To  a  pound 
of  meat  free  from  fat  add  a  quart  of  water  and  cook 
for  three  hours,  gradually  adding  water  so  that  when 
done  there  will  be  a  pint  of  broth.  When  this  is  cool, 
all  fat  should  be  skimmed  off,  and,  after  straining,  the 
broth  should  be  seasoned  with  salt. 

Beef  Juice. — This  is  prepared  by  broiling  a  round 
steak  very  rare,  cutting  it  iiito  pieces  an  inch  square, 
squeezing  out  the  blood  with  a  lemon-squeezer,  and 
adding  a  little  salt. 

Scraped  Beef. — After  a  round  steak  has  been 
broiled  rare  over  a  quick  fire,  it  is  cut  through  edge- 
ways and  the  pulp  scraped  from  the  inside  with  a  dull 
knife. 

Barley  Gruel  and  Barley-Water. — These  may  be 
made  either  from  the  grains  or  from  the  barley  flour. 
If  the  grains  are  used,  two  tablespoonfuls  should  be 
cooked  in  a  quart  of  water  for  at  least  three  hours, 
adding  water  so  that  when  done  there  shall  be  a  quart 
of  the  barley-water.  This  is  strained  through  coarse 
muslin  or  cheesecloth,  and  seasoned  with  salt;  when 
cool  it  makes  a  thin  jelly.  This  has  an  approximate 
equivalent  of  protein  .24  per  cent,  carbohydrates  1,20 
per  cent. 


78  THE  CHILD 

An  easier  and  more  satisfactory  way  to  make  barley 
jelly  is  to  use  the  barley  flour,  either  Robinson's  or 
that  made  by  the  Health  Food  Company  of  New  York, 
or  the  Cereo  Company's  barley  gruel  flour.  Two 
tablespoonfuls  of  this  flour  is  cooked  in  a  quart  of 
water  for  twenty  minutes.  If  a  stronger  gruel  for 
older  children  is  required,  three  or  four  level  table- 
spoonfuls  to  the  quart  of  water  may  be  used. 

ErcE- Water  and  Oatmeal-Water  are  made  in  the 
same  way  as  barley-water,  using  two  level  tablespoon- 
fuls, or  more,  of  either  the  flour  or  grains  to  a  quart 
of  water,  according  to  the  strength  desired. 

Barley,  Rice,  Oatmeal,  and  Wheat  Jelly  are 
made  by  using  four  tablespoonfuls  of  the  cracked 
grains  to  the  quart  of  water,  and  cooking  for  three 
hours,  then  straining  through  a  colander,  and  season- 
ing with  salt. 

Rice-water  and  barley-water  are  of  value  in  diar- 
rhoea, while  oatmeal- water  is  given  for  its  laxative 
effect  in  constipation. 

Egg  or  Albumen  Water  is  made  by  adding  the 
white  of  one  egg  that  has  been  thoroughly  beaten  to 
a  pint  of  cold  boiled  water,  with  a  pinch  of  salt  and 
a  teaspoonful  of  brandy  added.  It  is  useful  in  cases 
of  vomiting  and  very  irritable  stomachs. 

Dextrinized  Barley- Water  is  made  by  adding 
three  tablespoonfuls  of  Robinson's  barley  flour  to  a 
pint  of  water,  and  cooking  for  twenty  minutes,  enough 
water  being  added  during  the  cooking  to  make  a  pint 
of  barley-water  when  it  is  done.     When  cooled  to  a 


THE  CHILD  79 

temperature  of  100°  F.  a  pinch  of  salt  and  a  teaspoon- 
full  of  cereo  are  added. 

Whey. — Heat  a  pint  of  milk  until  it  is  lukewarm 
(100°  F.),  add  two  teaspoonfuls  of  Fairchild's  essence 
of  pepsin,  stir  a  little,  and  allow  it  to  stand  until 
jellied,  then  beat  with  a  fork,  and  strain  through 
cheesecloth.  The  indigestible  curd  remains  in  the 
cloth. 

Arrowroot  Gruel  is  made  by  boiling  two  tea- 
spoonfuls  of  arrowroot  in  a  pint  of  water  for  twenty 
minutes  and  then  straining.  It  is  of  service  in  diar- 
rha3a. 

Lime-Water. — Add  a  heaping  teaspoonful  of  slaked 
lime  to  a  quart  of  boiled  or  distilled  water,  keep  in 
a  corked  bottle,  and  shake  several  times;  then  allow 
the  lime  to  settle,  and  after  twenty-four  hours  the 
upper  clear  fluid  may  be  removed  for  use. 


RULES  FOR  FEEDING  CHILDREN 

A  very  important  part  of  a  chikFs  early  education 
is  learning  to  eat  proper  foods,  and  also  learning  the 
way  in  which  they  should  be  eaten,  for,  almost  in 
babyhood,  it  is  very  easy  for  children  to  acquire  habits 
which,  after  they  are  formed,  may  be  exceedingly 
hard  to  break. 

Meals  should  be  given  at  regular  intervals,  and  no 
food  should  be  allowed  between  meals,  even  if  the 
child  has  refused  food  at  the  regular  time. 

A  child  should  never  be  given  indigestible  food  in 


80  THE  CHILD 

order  to  stimulate  the  appetite,  in  the  hope  that  this 
may  induce  it  to  take  simple  food,  and  it  should  never 
be  allowed  to  play  with  its  food. 

It  is  never  necessary  to  amuse  a  child  while  it  is 
taking  a  meal,  so  that  it  will  eat  more.  A  child  should 
never  be  urged  or  forced  to  eat,  but  the  food  should 
be  removed,  and  when  the  next  meal-time  comes  the 
child  will  probably  be  ravenously  hungry. 

Children  should  not  be  allowed  to  eat  only  one  food 
at  a  meal,  and  should  they  refuse  to  eat  an  important 
article  of  their  diet — such  as  cereal,  vegetables,  milk, 
or  meat — that  particular  article  should  be  given  them 
first  before  the  appetite  is  satisfied,  and  all  other  food 
kept  back  until  the  cereal,  vegetables,  milk,  or  meat 
is  eaten. 

All  food  should  be  given  in  a  very  digestible  form : 
meats  should  be  cut  up  fine,  vegetables  thoroughly 
cooked,  so  that  they  can  be  mashed  fine  with  a  fork, 
and  cereals  cooked  until  they  are  very  soft. 

In  very  hot  weather  and  in  acute  illness  the  food 
should  always  be  reduced  both  in  strength  and  in 
amount. 

An  infant  may  refuse  its  food  altogether,  in  which 
case  a  careful  examination  should  be  made  of  the 
mouth  to  see  if  it  is  sore.  If  satisfied  that  this  is  not 
the  cause,  a  careful  examination  of  the  food  may 
show  it  to  be  sour,  or,  for  some  other  reason,  at  faultc 


THE  CHILD 


81 


PREMATURE  AND  WEAK  INFANTS 


In  the  care  of  premature  babies  three  things  are 
of  vast  importance  and  should  be  constantly  kept  in 
mind :  proper  nourishment,  proper  heat  in 
the  body,  and  abundance  of  fresh  air. 

The  digestive  organs  are  in  a  premature 
state  in  these  infants,  and  on  that  account 
the  most  digestible  food  must  be  given. 
Mother's  milk  fulfils  this  requirement,  and 
upon  this  these  infants  thrive  best.  As 
mother's  milk  is  rarely  to  be  had  at  first, 
a  wet-nurse  who  has  a  child  from  one  to 
two  months  of  age  should  be  obtained. 
The  wet-nurse  while  nursing  the  foster- 
child  should  nurse  her  own  as  well,  for  the 
premature  infant  will  be  unable  to  take 
all  her  milk,  and  its  weak  efforts  at  nursing 
will  soon  dry  up  the  breasts,  whereas  the 
vigorous  nursing  of  the  strong  child  will 
stimulate  the  flow  of  milk. 

When  the  premature  child  is  too  weak  to  nurse,  the 
milk  should  be  pumped  from  the  breasts  and  admin- 
istered by  means  of  the  Breck  feeder,  giving  at  first 
one-half  ounce  at  a  feeding,  ten  or  twelve  feedings 
being  given  in  the  twenty-four  hours.  If  it  is  im- 
possible to  obtain  a  wet-nurse,  whey,  a  diluted  cream 
mixture,  or  condensed  milk,  one  teaspoonful  to  three 
ounces  of  water,  may  be  given. 

In  order  to  keep  up  the  body  heat  the  child  should 
be  wrapped  in  cotton,  put  in  a  padded  crib,  and  hot 


Breck 
Feeder. 


82  THE  CHILD 

water-bottles  placed  about  it.  A  thermometer  should 
always  be  kept  between  the  cotton  surrounding  the 
child  and  the  bedclothes  in  order  to  regulate  the  tem- 
perature of  the  hot  water-bottles.  The  temperature 
registered  by  the  thermometer  should  be  from  85°  F.  to 
95°  F.,  the  degree  depending  on  the  temperature  of 
the  child ;  the  lower  the  temperature  of  the  child  the 
greater  should  be  the  artificial  heat. 

The  trouble  with  most  incubators  is  that  they  do 
not  supply  the  infant  with  a  sufficient  amount  of  pure 
air,  which  is  of  such  vital  importance. 

Most  physicians  have  had  little  success  in  raising 
premature  babies  in  incubators,  and  are  agreed  that 
similar  methods  to  those  above  described  are  the  best. 

For  these  delicate  infants  it  is  vital  to  avoid  any 
chilling  of  the  body.  For  the  first  few  weeks,  it  is 
better  to  omit  the  daily  bath  and  anoint  the  skin  with 
warm  oil  instead. 


MALNUTRITION  AND  MARASMUS 

If  a  child  fails  for  a  considerable  time  to  gain,  or 
even  loses,  weight,  this  denotes  a  state  of  malnutrition. 
There  are  all  grades  of  severity  in  under-nourished 
cases,  from  children  who  gain  very  little,  or  none  at 
all,  in  weight,  to  those  who  lose  rapidly.  A  few  of 
these  children  have  been  born  weak  and  delicate,  but 
most  are  in  this  condition  through  improper  feeding. 
The  food  has  been  given  too  strong,  too  weak,  too  much 
at  a  time,  too  often,  or  with  too  high  or  too  low  a 


THE  CHILD  83 

percentage  of  fat,  protein,  or  sugar.  In  other  words, 
it  has  not  been  properly  adapted  to  the  child.  The 
usual  story  is  that  after  a  few  trials  it  was  thought 
the  mother  could  not  nurse  her  baby  because  her  milk 
did  not  agree  with  the  child,  or  later  because  it  was 
thought  she  had  not  sufficient  milk,  or  because  the 
child  suffered  from  colic ;  then  artificial  food,  such  as 
modified  milk,  or  some  patent  meal  food,  is  substituted. 
One  after  another  these  are  tried  with  equally  sad 
results;  the  child's  weight  remains  stationary,  or 
steadily  decreases  until  it  becomes  a  living  skeleton. 

This  advanced  or  aggravated  form  of  malnutrition 
is  called  marasmus,  and  is  a  heavy  tax  upon  the  physi- 
cian's skill  and  the  mother's  patience.  These  emaci- 
ated little  sufferers,  with  their  whining,  restless  cry, 
dry,  wrinkled  skin,  hollowed  temples,  anxious,  old  ex- 
pression, and  protruding  abdomen,  form,  indeed,  one 
of  the  most  pathetic  pictures  the  physician  is  called 
to  look  upon.  Frequently  their  digestion  has  been 
so  upset  and  weakened  that  it  takes  a  long  time  before 
they  can  assimilate  food  of  such  strength  as  a  healthy 
child  of  the  same  age  should  take.  In  many  cases,  bar- 
ley or  rice  gruel. should  be  given  until  the  digestion  has 
improved;  then,  very  gradually,  a  little  cream  or 
cow's  milk  may  be  added;  and  later,  after  perhaps 
some  weeks,  the  child  may  be  gradually  brought  back 
to  a  regular  milk  diet. 

Malnourished  children  should  be  given  a  salt-water 
bath  every  day  at  a  temperature  of  105°  F.  This 
bath  should  not  last  longer  than  ten  minutes,  and  the 
child  should  be  thoroughly  rubbed  all  over  with  the 


84  THE  CHILD 

hand  while  in  the. water,  then  quickly  dried  with  a  bath 
towel,  and  rubbed  well  from  head  to  foot  with  cocoa 
butter  or  goose  oil.  Warm  clothing,  except  during  the 
hottest  months  of  summer,  should  be  worn,  and  flannel 
next  the  skin,  with  warm  stockings.  Frequently  it 
will  be  found  necessary  to  place  a  hot  water-bottle 
in  the  bed  at  the  feet  of  the  baby  to  keep  them  warm. 
Fresh  air  is  also  most  important,  and  when  the 
weather  is  warm  enough  they  should  be  kept  out-of- 
doors  all  day. 

During  the  winter  they  should  have  an  outdoor 
airing  of  an  hour  or  two,  except  when  the  weather 
is  inclement ;  then  all  the  windows  in  one  room  should 
be  opened,  and  so  an  indoor  airing  be  provided,  the 
child  being  dressed  as  for  outdoors  and  placed  in  a 
carriage  or  in  a  crib  with  hot  water-bottles  at  its  feet. 
During  the  night  the  windows  in  the  bedroom  should 
always  be  opened  for  ventilation.  Fresh  air  stimu- 
lates and  invigorates  the  baby,  gives  it  a  better  appe- 
tite, and  increases  its  power  to  take  stronger  food. 

The  management  of  hundreds  of  malnourished 
babies  during  the  past  twelve  years  has  taught  me 
that  the  greatest  care  and  patience  is  required  by  the 
mother  or  nurse,  and  by  the  physician  in  charge,  if 
the  child  is  to  be  restored.  It  is  only  by  adhering 
most  scrupulously  to  details  that  our  efforts  have 
been  rewarded  and  most  of  such  little  sufferers  saved. 


THE  CHILD  85 

"  COLD  SORE  "  OR  "  FEVER  SORE  " 

This  is  of  very  common  occurrence  in  young  chil- 
dren. There  may  be  one,  or  a  number  of  small  water- 
blisters  on  the  lips;  these  rupture,  and  crusts  are 
formed.  On  account  of  the  great  tendency  of  chil- 
dren to  pick  the  lips  ''  cold  sores  ''  may  be  long  in 
getting  well,  so  that  some  mechanical  means,  such  as 
the  ''  Iland-I-Hold  '^  babe  mits  to  restrain  the  child, 
should  be  used.  Spirits  of  camphor  applied  several 
times  a  day  is  healing  and  drying.  The  sore  should 
be  kept  clean  by  frequently  bathing  it  with  a  satu- 
rated solution  of  boracic  acid,  and  then  drying  it  with 
a  dusting  powder  of  equal  parts  of  boracic  acid  and 
zinc  oxide  powder.  Internally  a  brisk  cathartic  of 
a  glass  of  citrate  of  magnesia  water  should  be  given, 
and  a  teaspoonful  of  rhubarb  and  soda  mixture  three 
times  a  day. 

This  affection  is  usually  due  to  a  feverish  condition 
of  the  blood  and  to  hyperacidity  and  indigestion/ 


STOMATITIS,  SORE  MOUTH 

Stomatitis  may  be  catarrhal  in  its  mildest  form, 
characterized  by  redness  and  swelling  of  the  mouth 
and  gums,  with  salivation.  Or  it  may  be  of  the 
aphthous  variety,  which  is  canker  sore  mouth;  this 
appears  as  little  yellowish  areas  upon  the  mucous 
membrane  of  the  mouth  and  tongue  from  the  size 
of  a  pinhead  to  that  of  a  pea.     There  will  be  fever. 


86  THE  CHILD 

the  tongue  will  usually  be  coated,  and  the  child  will 
refuse  to  eat. 

Stomatitis  may  also  be  of  the  ulcerative  type.  This 
is  the  most  severe  and  serious  of  all  the  varieties. 
It  is  characterized  by  deep  ulcerations  of  the  gums 
at  their  junction  with  the  teeth;  the  gums  are  very 
red  and  swollen  and  bleed  easily;  the  teeth  may  be- 
come loosened,  or  even  fall  out ;  there  may  be  profuse 
salivation ;  and  in  some  cases  quite  high  fever,  coated 
tongue,  loss  of  appetite,  and  severe  pain  on  chewing. 

This  disease  is  due  to  uncleanliness  of  the  mouth, 
together  with  a  disordered  stomach.  Children  with 
stomatitis  should  be  given  a  saline  cathartic  and  their 
mouths  rinsed  frequently  with  a  saturated  solution 
of  boracic  acid,  or  some  other  mild  antiseptic  solution, 
such  as  borolyptol,  one  part  to  four  parts  of  water. 

These  cases  all  need  to  be  seen  by  a  physician,  as 
they  require  internal  medication  to  effect  a  cure. 


COLIC 

Colic  always  means  indigestion.  It  may  be  present 
in  the  breast-fed  or  in  the  bottle-fed  baby,  but  in 
every  case  it  indicates  that  the  food  does  not  assimi- 
late, in  other  words,  is  not  properly  adapted  to  the 
child.  The  most  frequent  cause  of  colic  in  this  con- 
nection is  too  high  a  percentage  of  protein,  which 
is  the  curd-forming  element  of  the  milk.  Another 
common  cause  is  too  frequent  feeding.  Therefore  the 
first  thing  to  be  done  is  to  correct  the  feeding,  which 


THE  CHILD  87 

often  is  the  only  thing  necessary  to  relieve  the  condi- 
tion. If  the  child  is  breast-fed  treatment  must  be 
given  the  mother.  It  will  usually  be  found  that  she, 
as  well  as  the  child,  is  habitually  constipated.  The 
mother  is,  perhaps,  a  hearty  eater  and  of  sedentary 
habits.  She  should  be  put  upon  a  simple,  easily 
digested,  substantial  diet,  with  tea  and  coffee  in  mod- 
eration only,  together  with  fresh  meat,  poultry,  cereals, 
soups,  green  vegetables,  fruit,  milk,  cocoa,  chocolate, 
and  a  generous  amount  of  water.  Her  bowels  should 
move  freely  every  day.  She  should  spend  three  hours 
in  the  open  air  each  day,  taking  gentle  exercise,  with 
care  not  to  become  over-fatigued. 

Fright,  anger,  worry,  or  menstruation  of  the  mother 
will  often  cause  serious  indigestion,  or  colic,  in  the 
child. 

In  an  attack  of  colic  the  child  cries  vigorously 
and  almost  incessantly  until  relieved,  the  face  becomes 
red,  the  legs  are  drawn  up,  the  fists  are  clenched,  the 
abdomen  is  distended  and  hard.  These  attacks  may 
come  on  at  any  hour  in  the  day  after  feeding,  but 
are  most  common  in  the  afternoon.  This  is  on  account 
of  frequent  feeding  during  the  day,  which  results  in 
an  overworked  stomach  towards  evening,  while  at 
night  the  stomach  gets  more  rest.  Children  may  have 
only  mild  attacks  of  colic  and  be  fairly  well  other- 
wise, but  frequent  and  severe  attacks  usually  denote 
malnourished  children.  A  baby  rarely  cries  except 
when  it  is  in  pain,  cold,  or  hungry;  its  tendency  is 
always  to  smile,  play,  and  be  happy.  Thus,  if  one 
baby  cries  more  than  another,  it  is  not  because  it  is 


S8  THE  CHILD 

bad-tempered,  but  because  the  crying  baby  suffers 
more  than  the  other. 

Colic  is  most  commonly  seen  in  babies  under  six 
months  of  age. 

In  the  treatment  of  habitual  colic  the  first  require- 
ments are  to  adapt  properly  the  food  to  the  child's 
digestion,  to  relieve  the  attack  by  an  injection  or  enema 
of  eight  ounces  of  warm  salt-water,  a  hot  water-bottle 
placed  at  the  feet,  and  hot  applications  placed  over 
the  abdomen  (these  may  be  flannels  wrung  out  in 
hot  water) .  Hot  water  should  also  be  given  by  mouth 
with  a  medicine  dropper  and  a  few  drops  of  well- 
diluted  brandy,  or  peppermint  water  should  be  added. 
Soothing  syrups  should  never  be  given. 


VOMITING 

Many  causes  may  produce  vomiting.  While  it  usu- 
ally attends  an  acute  attack  of  indigestion,  as  the  re- 
sult of  improper  food  or  feeding,  it  may  be  a  symptom 
attending  the  onset  of  any  of  the  acute  diseases,  such 
as  scarlet  fever,  pneumonia,  or  meningitis.  Immedi- 
ately upon  the  occurrence  of  vomiting,  all  milk  feeding 
should  be  discontinued  and  only  boiled  water  or 
barley-water  given,  and  that  in  small  quantities  every 
three  hours ;  but  where  the  boiled  water  or  barley- 
water  causes  vomiting  nothing  whatever  should  be 
given  until  it  ceases.  In  severe  cases  it  will  be  found 
necessary  to  continue  to  give  only  water  or  barley- 
water  for  from  twenty-four  to  forty-eight  hours  before 


THE  CHILD  89 

a  more  substantial  diet  will  be  retained,  and  then  the 
milk  must  be  given  diluted  four  to  eight  times  with 
water,  and  gradually  strengthened  as  it  is  found  that 
the  child  can  retain  and  digest  it. 

In  many  cases  the  quickest  means  of  relieving  the 
little  patient  is  by  washing  out  the  stomach,  using  a 
small  stomache-tube  for  the  purpose.  This  will  usu- 
ally bring  about  a  very  speedy  cure. 

HABITUAL  VOMITING 

It  is  not  uncommon  for  babies  to  regurgitate,  or 
vomit,  a  part  of  each  feeding,  especially  when  they  are 
very  young. 

This  invariably  means  that  the  food  is  too  strong, 
or  that  too  much  is  taken  at  a  time.  Often  it  will 
be  found  that  the  feedings  are  given  at  too  frequent 
intervals. 

The  treatment  consists  in  suitably  adapting  the  milk 
and  regulating  the  intervals  of  feeding  in  the  arti- 
ficially-fed, and,  for  breast-fed  children,  making  an 
examination  of  the  breast  milk,  and  if  that  is  found 
at  fault,  correcting  it,  if  possible,  by  suitable  regula- 
tion of  the  mother's  diet,  exercise,  habits,  etc.  If  too 
frequent  nursings  have  been  given  they  should  be  de- 
creased in  number.  Although  habitual  vomiting  may 
not  cause  serious  trouble  or  loss  of  weight,  yet  it  is 
always  an  indication  that  the  stomach  is  overtaxed, 
and  in  case  of  serious  illness,  or  during  very  hot 
weather,  the  child  with  whom  vomiting  has  been  habit- 
ual will  not  have  the  same  resistance  as  will  the  child 
which  has  properly  assimilated  its  food. 


90  THE  CHILD 

DIARRHCEA 

More  deaths  in  infancy  are  due  to  diarrhoea  than 
to  any  other  cause;  about  fifty  thousand  children 
under  two  years  of  age  died  from  this  cause  alone  in 
the  United  States  during  the  year  1908.  About  three- 
quarters  of  the  fatal  cases  of  diarrhoea  are  artificially- 
fed  babies. 

Errors  in  diet  are  accountable  for  the  vast  majority 
of  cases  of  diarrhoea,  but  occasionally  other  causes, 
such  as  extreme  heat,  fright,  sudden  changes  in  the 
weather,  etc.,  may  be  the  causative  factor. 

Diarrhoea  is  an  effort  on  the  part  of  nature  to  elimi- 
nate poison,  or  whatever  the  irritation  may  be,  from 
the  system. 

During  the  hot  weather  a  child  cannot  digest 
as  strong  food  as  it  is  in  the  habit  of  taking  when 
the  weather  is  cool.  Consequently,  if  the  same  diet  is 
given,  indigestion  is  very  likely  to  occur,  with  fermen,- 
tation,  and  the  formation  of  gases  and  poisons;  or 
if  undigested  food  remains  in  the  intestines  it  will 
cause  irritation  to  the  bowel,  and  diarrhoea  will  be  the 
result. 

Mild  diarrhoea  may  develop  into  a  serious  or  even 
dangerous  condition  in  a  few  hours. 

Cholera  infantum  is  the  worst  and  most  dangerous 
type  of  the  disease.  Its  onset  is  usually  sudden  and 
severe,  but,  on  the  other  hand,  it  may  be  gradual,  with 
all  gradations  of  severity,  from  slight  fever,  vomiting, 
and  four  or  five  greenish  stools  each  day,  and  little 
or  no  prostration^  to  high  fever  (104°  F.  to  106°  F.), 


THE  CHILD  91 

with  frequent  vomiting,  first  of  food,  then  of  mucus 
and  bile.  This  condition  may  be  accompanied  with 
constipation,  or  foul-smelling  green  or  brown  stools, 
in  number  from  five  to  thirty  in  the  twenty-four  hours, 
and  containing  large  amounts  of  mucus. 

When  very  frequent  the  stools  may  consist  almost 
entirely  of  mucus  and  water.  They  are  also  some- 
times tinged  with  blood.  In  the  severe  type  of  the 
disease  the  condition  is  one  of  great  prostration,  with 
rapid,  thready  pulse,  cold  extremities,  sunken  eyes, 
leaden  hue,  open  mouth,  shallow  and  irregular  breath- 
ing. The  child  has  apparently  succumbed  to  the 
poison,  and  it  seems  as  though  each  breath  might  be 
the  last. 

Of  the  many  hundred  cases  of  gastro-enteric  disease 
that  come  each  year  under  my  care,  only  a  few  are 
of  this  last,  and  most  severe,  type. 

In  all  cases,  the  first  duty  is  to  stop  at  once  all 
milk,  either  breast  or  bottle,  and  all  other  food.  The 
child  should  be  put  to  bed,  where  it  can  be  absolutely 
quiet,  and  given  an  initial  dose  of  castor-oil.  Chil- 
dren under  three  months  of  age  should  have  nothing 
but  plain  boiled  water  or  sugar-water  in  place  of 
milk ;  children  over  that  age,  barley  jelly  or  barley- 
water.  After  twenty-four  to  forty-eight  hours  of  this 
diet,  if  there  are  only  two  or  three  stools  a  day  and 
the  vomiting  has  ceased,  the  child  may  be  allowed  to 
take  the  breast  for  every  other  feeding.  After  a  day 
or  two,  if  all  goes  well,  the  breast  may  be  given  at 
every  feeding.  For  bottle-fed  babies  the  milk  will 
have  to  be  resumed  very  cautiously,  and  it  may  be 


92  THE  CHILD 

that  whey,  or  condensed  milk,  or  some  malt  prepara- 
tion, should  be  given.  In  many  cases  it  will  not  be 
possible  to  give  fresh  cow's  milk  during  the  heated 
term,  making  it  necessary  to  select  some  other  food 
until  cool  weather.  Even  then  the  cow's  milk  should 
be  added  very  gradually,  a  little  at  a  time,  until  the 
child  is  brought  back  to  a  proper  nutritious  diet. 


CONSTIPATION 

Constipation  frequently  occurs  in  infants  and  young 
children,  and  in  many  cases  is  most  obstinate  and 
annoying.  It  is  seen  both  in  bottle-fed  and  breast- 
fed babies,  and  also  in  older  children. 

In  cases  of  the  breast-fed  baby  the  fault  usually 
lies  with  the  mother.  Almost  without  exception  it 
will  be  found  that  she  is  habitually  constipated,  is  of 
sedentary  habits  and  a  hearty  eater,  and  not  infre- 
quently drinks  a  considerable  amount  of  tea. 

i[Jsually  babies  can  be  relieved  by  regulating  the 
habits  and  diet  of  the  mother,  who  should  take  at 
least  three  hours  exercise  each  day  out-of-doors,  and 
should  see  that  she  has  a  free  evacuation  of  the  bowels 
every  day.  Her  diet  should  be  simple  but  substantial, 
with  fruit,  cereals,  red  meat,  vegetables,  milk,  and 
cocoa.  Very  often  an  examination  of  the  mother's 
milk  will  show  a  deficiency  of  fat. 

If  the  constipation  in  the  child  persists  after  the 
above  measures  have  been  taken  it  should  be  given 
one-half  to  a  teaspoonful  of  gravity  cream  in  a  small 


THE  CHILD  93 

amount  of  hot  water  three  times  a  day.  If  this  does 
not  accomplish  the  desired  result  it  may  be  necessary 
to  repeat  the  dose  before  every  second  feeding,  or 
even  every  feeding  for  a  while. 

A  moderate  amount  of  malt  liquors,  such  as  beer 
or  ale,  taken  by  the  mother  with  meals  will  increase 
the  amount  of  fat  in  the  milk. 

Constipation  in  bottle-fed  babies  is  usually  due 
either  to  excess  of  protein,  or  insufficient  fat,  in  the 
milk.  Children  should  never  be  given  a  milk  con- 
taining more  than  four  per  cent  of  fat,  nor  should 
the  protein  be  reduced  to  below  one  per  cent  in  a 
child  under  six  months  of  age,  and  for  proper  nutri- 
tion 1.5  per  cent  is  desirable,  so  that  in  adapting  the 
milk  to  the  child  these  limits  should  be  our  guide. 

Constipated  infants  should  always  be  given  raw 
milk,  as  cooking  has  a  constipating  effect  upon 
milk. 

The  food  given  to  constipated  infants  can  be  made 
more  laxative  and  at  the  same  time  more  nourishing 
by  diluting  the  milk  with  oatmeal  water  instead  of 
plain  water. 

Malted  milk  has  usually  a  laxative  effect  and  may 
be  substituted  for  cow^s  milk  at  one  of  the  feedings 
each  day,  suiting  its  strength  to  the  age  of  the  child, 
A  teaspoonful  of  orange  juice  three  times  a  day  is 
of  value  as  a  laxative,  and  I  advise  it  in  all  my  feed- 
ing cases,  irrespective  of  constipation,  as  it  prevents 
any  tendency  toward  scurvy.  Sweet-oil  or  pure  cod- 
liver  oil  are  recommended  also,  especially  in  mal- 
^ourishe(J  or  rickety  babies.     The  oil  should  be  given 


94  THE  CHILD 

in  doses  of  ten  to  thirty  drops  three  times  a  day  after 
feeding. 

If  after  the  above  measures  the  stools  are  still 
constipated,  I  advise  an  injection  composed  of  two 
ounces  of  warm  sweet-oil.  This  should  be  given  just 
before  the  child  is  put  to  bed  for  the  night,  and 
should  be  retained  in  the  bowels  over  night. 

Water  enemata  or  suppositories  should  not  be  given 
habitually,  as  they  will  cause  irritation  of  the  bowels 
and  the  child  will  get  to  depend  upon  them  for  a 
movement.  Drugs  are  rarely  necessary  and  should 
never  be  given  except  under  the  guidance  of  a  physi- 
cian. If  the  suggested  measures  are  faithfully  em- 
ployed they  will  probably  be  quite  sufficient  to  bring 
about  regularity  of  movement. 

Constipation  in  older  children  may  be  due  to  too 
concentrated  a  diet,  fissure  in  ano,  or  piles.  Perhaps 
the  commonest  cause  is  the  use  of  large  quantities 
of  whole  milk,  especially  if  it  has  been  cooked.  Chil- 
dren who  take  a  good  deal  of  milk  want  little  else, 
and  consequently  do  not  get  enough  of  the  coarser 
foods  which  act  upon  the  bowels.  Many  children 
have  not  been  taught  regularity  in  their  habits. 

Constipation  in  older  children  is  treated  by  adopt- 
ing a  diet  of  cereals,  fresh  vegetables,  meat,  fresh 
fruits,  eggs,  whole-wheat  biscuits,  graham  crackers, 
and  other  coarse  breads.  If  milk  is  given  at  all  it 
should  be  raw,  and  in  the  shape  of  diluted  cream, 
which  is  made  by  taking  the  upper  half  of  a  quart 
of  milk  on  which  the  cream  has  risen  and  diluting 
it  with  water.     In  very  bad  cases  of  constipation, 


THE  CHILD 


95 


white  bread  should  not  be  given ;  milk  also  had  better 
be  omitted  entirely  from  the  diet,  and  cocoa,  choco- 
late, and  water  given  instead. 

Every  morning  at  a  certain  hour  the  child  should 
be  placed  on  the  chamber  and  kept  there  for  fifteen 
minutes;  establishing  this  habit  will  help  to  overcome 


Syringe  for  Oil  Enema. 

constipation.  If,  after  all  these  changes  in  the  diet 
have  been  followed  out  faithfully,  constipation  still 
persists,  it  will  be  necessary  to  employ  drugs  and 
make  use  of  the  oil  enema  in  order  to  eflfect  a  cure. 


HICCOUGH 

This  is  quite  a  common  affection  among  babies  and 
is  usually  due  to  indigestion,  or  overloading  the 
stomach.  It  is  caused  by  a  sudden  spasmodic  con- 
traction of  the  diaphragm,  and  at  the  same  time  a 
closure  of  the  glottis.  This  condition  results  from 
irritability  of  the  stomach,  which  affects  the  nerves 
of  the  diaphragm. 

In  older  children,  hiccough,  like  spasmodic  crying, 
coughing,  and  laughing,  often  accompanies,  or  results 
from,  hysteria. 


96  THE  CHILD 

For  an  immediate  attack,  babies  should  be  given 
hot  water,  a  few  drops  of  brandy  in  water,  or  a  few 
drops  of  Hoffmann's  Anodyne  in  water,  and  the  feed- 
ing should  be  regulated.  It  may  be  necessary  to 
lengthen  the  intervals  of  feeding  or  shorten  the  time 
at  the  breast. 

In  the  case  of  older  children,  holding  the  breath, 
blows  on  the  back,  or  swallowing  water  may  be  tried. 
In  the  more  severe  cases,  a  cold  shower-bath  should 
be  given.  If  this  treatment  does  not  afford  relief 
a  physician  should  be  called,  ether  sprayed  on  the 
abdomen,  and  other  remedies  administered — such  as 
chloroform,  musk,  Hoffmann 's  Anodyne,  or  sulphonal, 
in  order  to  overcome  the  spasm. 


FISSURE  OF  THE  ANUS 

These  are  slight  tears  in  the  mucous  membranes  at 
the  anal  opening.  They  may  occur  as  a  result  of  con- 
stipation followed  by  hard  lumpy  movements.  Such 
movements  cause  a  good  deal  of  stretching  as  they 
pass  through  the  anus. 

Rupture  of  the  mucous  membrane  or  fissure  may 
also  occur,  as  a  result  of  the  straining,  and  excoriating 
discharges  of  diarrhoea. 

A  fissure  of  the  anus  will  cause  great  pain  at  each 
movement  of  the  bowels;  so  acute  is  the  pain  that  a 
child  will  often  shriek  at  each  paroxysm,  and  older 
children  will  delay  having  a  movement  as  long  as 
possible  because  they  dread  the  pain, 


THE  CHILD  97 

The  patient  when  constipated  will  be  relieved  by 
suitable  diet  and  laxatives  which  keep  the  movements 
soft. 

Appropriate  diet  and  medication  will  overcome  the 
diarrhoea  if  present.  Besides  this,  the  fissure  will 
need  to  be  treated  locally  by  a  physician  to  bring 
about  a  cure. 

WORMS 

There  are  three  varieties  of  intestinal  worms  which 
may  occur  in  children — threadworms,  roundworms, 
and  tapeworms. 

Threadworms  look  like  little  pieces  of  white  thread 
from  a  quarter  to  half  an  inch  in  length.  They  cause 
great  itching  or  irritation  about  the  anus  and  are 
especially  annoying  after  the  child  gets  warm  in  bed. 
They  may  cause  such  burning  sensations  about  the 
anus  as  to  keep  the  child  awake  and  produce  nervous 
symptoms.  They  are  sometimes  evacuated  in  large 
numbers  with  the  stools,  and  several  hundred  may 
infect  the  bowels  at  a  time. 

Roundworms,  although  not  so  frequently  seen  as 
pinworms,  are  of  fairly  common  occurrence  from  the 
second  to  the  tenth  year.  The  symptoms  are  not 
characteristic  and  may  be  very  indefinite.  In  fact, 
not  infrequently  the  diagnosis  is  first  made  by  the 
passage  of  one  or  more  worms  which  resemble  some- 
what the  common  earthworm,  except  that  they  taper 
to  a  point  at  each  end.  They  are  white  and  vary 
in  length  from  four  to  seven  or  eight  inches. 


98  THE  CHILD 

Children  suffering  from  roundworms  may  have 
poor  appetites,  sleep  badly,  or  grind  their  teeth  at 
night,  and  pick  their  noses,  but  the  more  reliable 
symptoms  are  diarrhoea  and  constipation,  colic  and 
indigestion.  The  eggs  may  be  seen  in  the  stools. 
In  rare  instances  roundworms  have  been  known  to 
cause  convulsions. 

Tapeworms  seldom  occur  in  children  of  this  country 
and  give  no  characteristic  symptoms.  In  cases  which 
I  have  seen,  the  children  have  been  thin  and  pale, 
with  abnormally  large  appetites,  and  have  had 
more  or  less  indigestion,  with  constipation  or  diar- 
rhoea. Usually  the  first  symptom  noticed  is  a  dis- 
charge from  the  bowels  of  part  of  the  worm,  which 
may  be  a  number  of  feet  in  length  and  looks  like 
small  pieces  of  white  tape  linked  together.  As  long 
as  the  head  remains  the  worm  continues  to  grow  and 
feed  upon  its  host,  and  at  intervals  segments  may 
ccme  away  in  the  stools. 

Worms  may  cause  serious  troubles  if  not  eradicated 
by  proper  medication  and  treatment.  For  this  reason 
no  mother  should  rely  altogether  upon  home  remedies 
in  her  efforts  to  get  rid  of  these  troublesome  guests. 


INFANTILE  SCURVY 

This  is  a  disease  of  infancy  characterized  by  its 
gradual  and,  sometimes,  almost  insidious  onset. 
There  is  anaemia,  the  child  gradually*  changing  from 
a  healthy  color  to  waxy-white.     There  is  pain  at  first 


THE  CHILD  99 

on  handling,  and  the  child  cries  out  lustily  when 
touched;  finally,  it  does  not  move  the  affected  limb, 
and  acts  as  if  paralyzed,  while  the  other  is  moved 
freely.  Swellings  may  appear  upon  one  or  more  bones, 
most  frequently  upon  the  lower  extremities.  The 
ribs  may  be  separated  from  the  cartilages,  causing  the 
front  of  the  chest  to  sink  in.  The  gums  are  red, 
swollen,  and  soft,  and  bleed  at  the  slightest  touch, 
but  with  children  without  teeth  the  gums  may  appear 
normal. 

There  may  be  small  hemorrhages  under  the  skin, 
mucous  membranes,  or  conjunctiva,  and  there  may  be 
bloody  urine  or  blood  in  the  stools ;  these  latter  symp- 
toms, however,  are  rare.  There  is  usually  no  fever, 
and,  though  in  a  small  percentage  of  cases  it  may  be 
present,  it  is  rarely  as  high  as  102°  F.,  is  variable, 
and  is  usually  caused  by  complications. 

Scurvy  is  most  common  in  infants  under  one  year 
of  age,  and  is  rare  after  the  second  year.  Scurvy 
results  from  feeding  babies  proprietary  foods,  con- 
densed milk,  sterilized,  or  boiled  milk,  as  a  steady 
diet. 

Of  forty-two  of  my  own  cases  all  could  be  traced 
to  these  causes.  It  never  occurs  in  breast-fed  children 
and  is  purely  a  food  or  nutritional  disease. 

The  treatment  is  fresh  raw  cow's  milk,  raw  beef 
juice,  and  orange  juice.  With  older  children  scraped 
apples,  lemon  juice,  oatmeal  gruel,  and  chicken  broth 
may  also  be  given.  The  raw  milk  is  given  as  a  food, 
and  the  orange  juice  and  beef  juice  given  from  one 
to  two  f^aspoonfuls  three  or  four  times  a  day. 


100  THE  CHILD 

It  may  take  weeks  or  months  for  this  disease  to 
develop,  but,  if  properly  treated,  it  can  be  cured  in 
from  three  days  to  two  weeks,  according  to  its  sever- 
ity. There  are  different  grades  of  severity  and  only 
two  or  three  of  the  symptoms  may  be  present. 

Those  symptoms  most  frequently  seen,  according  to 
my  observations,  are  pain  on  handling,  more  or  less 
prostration,  swelling  of  one  of  the  lower  extremities, 
sponginess  of  the  gums — which  bleed  easily — fretful- 
ness,  disinclination  to  take  food,  and  stationary  weight, 
or  loss  of  weight. 

RICKETS 

Rickets  is  a  nutritional  disease  affecting  the  bones, 
muscles,  nervous  system,  and  other  organs  of  the 
body.  It  comes  as  a  result  of  improper  nourishment 
or  ill-adapted  food. 

Children  with  rickets  are  pale,  have  flabby  muscles, 
and  dentition  is  delayed,  and,  not  infrequently,  diffi- 
cult. The  fontanelles  are  very  slow  about  closing; 
there  is  often  curvature  of  the  spine;  the  head  is 
large  and  cubical  in  shape ;  the  ends  of  the  long  bones 
may  be  enlarged,  and  the  child 's  ribs  become  beaded ; 
there  is  sinking  in  of  the  chest-wall,  and  the  legs 
may  be  bowed  on  account  of  the  softness  of  the  bones. 
The  abdomen  is  large,  and  the  child  often  sweats 
about  the  head  and  neck.  Children  so  affected  are 
frequently  small  for  their  age  and  under  weight; 
they  are  poor  sleepers,  restless,  irritable,  subject  to 
convulsions,  and  very  slow  about  learning  to  creep, 


THE  CHltD  '  [J  \\W: 

sit,  stand,  and  walk.     Their  mentality  is  also  below 
that  of  healthy  children. 

The  treatment  of  this  disease  is  proper  food,  fresh 
air,  salt-baths,  oil  rubs,  maltine  and  cod-liver  oil,  iron 
tonics,  etc.,  but  most  important  of  all  is  a  proper 
diet  suitable  for  the  age,  as  indicated  elsewhere  under 
the  heading  of  diet. 


TAKING  COLD 

Taking  cold  is  the  result  of  a  sudden  chilling  of  the 
surface  of  the  body,  which  produces,  usually,  a  conges- 
tion of  the  mucous  membranea^of  the  respiratory  tract. 
Taking  cold  comes  from  undue  exposure,  especially 
when  the  skin  is  moist  and  perspiration  abundant,  as  is 
often  the  case  when  the  child  is  dressed  for  an  out- 
door airing  and  left  bundled  up  in  a  warm  room  until 
the  nurse  is  ready.  Then,  when  it  is  taken  out  into 
the  cold  air,  the  sudden  change  is  so  great  that  the 
child  takes  cold.  Children  that  live  in  very  warm 
houses,  that  are  burdened  with  too  much  clothing, 
or  become  overheated  with  active  play  are  very  apt 
to  take  cold.  Wet  feet,  exposure  to  raw  winds  and 
melting  snow  are  all  causes  that  induce  colds. 

An  infant  or  young  child  should  always  have  its 
own  handkerchief,  and  never  under  any  circumstances 
should  a  handkerchief  be  used  for  more  than  one 
person. 

There  is  no  doubt  that  bacteria  play  an  important 
role  in  the  ordinary  cold,  and  after  congestion  of  the 


\U2  .^THiG  CHILD 

mucous  membrane  has  once  occurred  it'  makes  a  good 
field  for  the  bacteria  to  work  upon. 

A  mother  or  nurse  should  never  hold  a  child  in  a 
draft,  as  before  an  open  window,  or  take  it  into  a 
cold  room  or  drafty  hall  in  cold  weather,  when  it  is 
insufficiently  or  improperly  clothed,  as  this  is  a  com- 
mon way  to  induce  a  cold.  To  allow  rooms  to  become 
overheated  during  the  day  and  too  cold  at  night  is 
also  a  fruitful  source  of  colds.  A  child  will  perhaps 
be  put  to  bed  in  a  warm  room  and  will  kick  the  bed- 
clothes off ;  later  in  the  night  the  room  grows  cool,  the 
child  becomes  chilled,  and  most  likely  a  cold  will  be 
the  result. 

If  mothers  would  guard  against  these  causes  they 
could  do  much  to  prevent  the  all  too  frequent  colds. 


COLD  IN  THE  HEAD 

This  is  a  very  common  condition  in  babies  and 
young  children,  and,  although  usually  not  serious 
when  it  affects  only  the  mucous  membranes  of  the 
nose,  there  is  danger  that  in  infants  the  inflamma- 
tion may  spread,  causing  bronchitis  or  broncho-pneu- 
monia. 

The  first  symptom  to  be  noticed  is  that  the  child 
breathes  with  difficulty,  and  when  nursing  often  has 
to  stop,  drop  the  nipple,  and  gasp  for  breath.  This 
is  caused  by  the  congestion  of  the  mucous  membrane 
of  the  nose,  which,  by  its  swelling  and  the  watery 
secretion  always  present,  almost  entirely  stops  up  the 


THE  CHILD  103 

baby's  small  nostrils.  There  is  usually  only  a  degree 
or  two  of  fever.  In  very  young  infants  this  stoppage 
of  the  nasal  passages  has  been  known  to  cause  severe 
asphyxia,  as  they  do  not  know  how  to  breathe  through 
the  mouth. 

Children  with  colds  in  the  head  should  be  kept  in 
a  room  where  the  air  is  moist,  at  a  temperature  of 
70°  F.  The  eyes  should  be  washed  with  a  saturated 
solution  of  boracic  acid,  and  every  hour  or  so  a  little 
liquid  albolene,  alone,  or  to  which  a  small  amount  of 


<^jj 


ii,ii:!ii)iiijKiiii....!'.'iii  ^  «"»'iyi|ii.'/^ 


The  Birmiughaiu  Douche. 

menthol  and  camphor  may  be  added — camphor,  one 
grain ;  menthol,  two  grains ;  albolene,  one  ounce — 
should  be  put  in  each  nostril  by  means  of  a  little 
absorbent  cotton  twisted  on  the  end  of  a  wooden  tooth- 
pick; or  a  little  camphorated  cold-cream  or  vaseline, 
or  sweet-oil  may  be  used.  An  initial  dose  of  castor- 
oil  before  the  physician  arrives,  is  of  advantage. 
Watery  douches  should  never  be  used  in  the  nose  of 
an  infant,  as  they  may  spread  the  infection  to  the 
middle  ear,  which  is  one  of  the  commonest  complica- 
tions. 


104 


THE  CHILD 


In  older  children,  where  the  discharge  from  the 
nose  is  thick  and  tenacious  and  the  condition  has 
reached  a  subacute  stage,  a  cleansing  nasal  douche 
of  warm  salt-water,  or  some  mild  healing  antiseptic 
solution,  such  as  borolyptol,  one  part  to  ten  of  water, 
should  be  given  several  times  a  day.  The  Birming- 
ham Douche  can  be  used  for  this  purpose.     After 


Oil  Nebulizer. 


the  cleansing  douche  a  small  amount  of  liquid  albo- 
lene,  alone,  or  with  menthol  and  camphor — menthol, 
four  grains ;  camphor,  two  grains ;  albolene,  one  ounce 
— can   be   sprayed   with   an   oil   atomizer  into   each 


THE  CHILD  105 

nostril.  This  soothes,  stimulates,  and  protects  the 
mucous  membrane,  and  hastens  a  cure. 

If  the  cold  in  the  head  is  the  result  of  measles, 
nasal  diphtheria,  or  adenoids  it  should  receive  the 
proper  treatment,  which  is  described  elsewhere. 

It  should  be  remembered  that  colds  are  more  or 
less  contagious,  so  that  adults  suffering  with  colds 
should  not  be  allowed  near  babies  or  young  children. 
We  must  bear  in  mind  also  that  a  cold  in  the  head 
may  be  the  first  symptom  of  measles,  nasal  diphtheria, 
or  influenza. 


PROPER  WAY  TO  EXAMINE  THE  THROAT 

It  is  important  that  a  mother  should  know  how  to 
examine  a  child's  throat.  The  illustration  shows  the 
method  of  holding  the  child  securely  while  making 
this  examination.  The  nurse,  either  standing  or  sit- 
ting facing  a  window,  her  right  hand  and  arm  placed 
under  its  buttocks,  holds  the  child  from  slipping 
down,  while  her  left  hand  and  arm,  passed  across 
the  front  of  its  body,  holds  the  hands  securely  pin- 
ioned to  its  sides.  The  one  who  is  making  the  ex- 
amination, now  with  the  left  hand  over  the  child's 
forehead,  presses  its  head  back  firmly  against  the 
nurse's  chest  or  shoulder,  then,  using  the  handle  end 
of  a  teaspoon  as  a  tongue  depressor,  presses  down 
the  tongue,  and  thus  has  full  view  of  the  back  of 
the  throat.     This  method  gives  the  examiner  perfect 


106 


THE  CHILD 


control   over  the   child   and  insures  a  thorough   ex- 
amination. 


THE  NORMAL  APPEARANCE  OF  THE  THROAT 

Every  mother  should  be  taught  to  know  the  appear- 
ance of  a  normal  throat,  so  that  she  may  distinguish 


Proper  Way  to  Examine  the  Throat. 


an  abnormal  condition  when  it  presents  itself  and 
be  able  to  take  immediate  measures  for  its  relief. 
She  should  know  at  a  glance  if  the  throat  is  inflamed, 
or  if  there  are  whitish  or  yellowish  dots  upon  it,  or 


THE  CHILD  107 

gray-looking  patches  in  the  throat  or  on  the  tonsils. 
She  should  be  able  to  tell  if  the  throat  looks  redder 
than  normal,  since  redness,  inflammation,  or  the  ap- 
pearance of  spots  or  patches  demands  the  presence 
of  a  physician,  as  this  condition  may  be  the  beginning 
of  serious  illness,  such  as  scarlet  fever,  measles,  ton- 
silitis,  or  diphtheria. 


,   TONSILITIS 

Tonsilitis  is  a  very  common  affection  among  infants 
and  young  children  during  the  winter  and  spring 
months.  Usually  the  attack  is  sudden,  with  tempera- 
ture of  103°  or  104°  F.  The  symptoms  are  restless- 
ness and  peevishness,  and  refusal  to  take  food  on 
account  of  pain  in  the  throat. 

The  tonsils  are  cjwoUen  and  of  a  deep  red  color, 
with  frequently  small  whitish  or  yellowish  specks  on 
them.  These  latter  may  later  coalesce  and  form  white 
or  yellow  patches  which  resemble  very  closely  the 
membrane  of  diphtheria,  and  can,  in  some  instances, 
be  distinguished  only  by  a  bacteriological  examination. 

Mtich  can  be  done  in  tonsilitis  to  relieve  the  pain 
in  the  throat  and  hasten  a  cure  by  local  applications 
and  internal  remedies.  Before  the  physician  arrives, 
cold  compresses  may  be  applied  to  the  throat,  the 
patient  given  a  bath  and  a  dose  of  castor-oil,  and, 
if  old  enough,  a  gargle  of  hydrogen  peroxide. 


108 


THE  CHILD 
ADENOIDS 


These  tumor-like  growths  develop   as   a  result  of 
hypertrophy,  or  chronic  enlargement,  of  the  mucous 


Way  to  Apply  a  Compress  to  the  Throat. 


glands  of  the  nasopharynx.  They  may  be  as  small 
as  a  kernel  of  rice,  or  as  large  as  a  walnut  and  com- 
pletely obstruct  the  opening  which  leads  from  the 
nose  to  the  throat. 

The  necessity  for  prompt  treatment  of  this  con- 
dition in  infancy  and  early  childhood  seems  not  to 


THE  CHILD  109 

be  fully  appreciated  by  parents  and  the  general  prac- 
titioner. Too  much  emphasis,  however,  cannot  be 
placed  on  the  fact  that  adenoid  growths  of  the  naso- 
pharynx are  probably  responsible  for  more  minor  ail- 
ments in  infants  and  young  children  than  any  other 
pathological  condition  found,  and  if  appropriate 
measures  are  not  taken  for  their  relief  they  may  be 
the  source  of  grave  after-troubles. 

According  to  G.  L.  Richards,  seventy  per  cent  of 
all  cases  of  adenoid  vegetations  occur  between  the 
ages  of  one  and  fifteen  years,  and  Bosworth  's  Statis- 
tics make  it  appear  that  in  ninety  per  cent  of  his 
cases  the  adenoids  developed  in  infancy  or  early 
childhood. 

My  own  records  show  from  thousands  of  cases 
treated  that  adenoids  are  most  frequent  in  children 
over  six  months  of  age  and  up  to  the  sixth  or  eighth 
year.  The  youngest  patient  I  have  operated  on  was 
six  weeks  old.  There  are  many  predisposing  factors 
which  may  favor  the  generation  and  growth  of  ade- 
noids, but  among  the  commonest  are  repeated  colds 
in  the  head,  the  use  of  the  *'  pacifier,''  living  in  small 
and  poorly  ventilated  rooms,  and  dust-laden  city  air. 
Heredity  also  plays  a  part  in  the  propagation  of 
adenoids;  they  are  more  frequent  in  some  families 
than  in  others,  and  several  children  in  the  same  family 
may  be  affected. 

One  of  the  commonest  symptoms  of  adenoids  is 
chronic  cold  in  the  head,  and  children  so  affected 
^re  s?ii(J  to  catch  Qold  easily  and  have  snuffles  all 


no  THE  CHILD 

winter.  A  hacking  cough  which  is  worse  at  night  is 
also  very  suggestive  of  adenoids. 

Adenoids  may  indirectly  be  the  cause  of  headache, 
earache,  and  abscess  of  the  ear.  Dr.  Dench  tells  us 
^'  Adenoids  are  responsible  for  more  than  half  of 
the  pathological  conditions  met  with  in  the  middle 
ear. ' ' 

At  birth  the  postnasal  space  is  very  small,  being 
only  one-quarter  of  an  inch  high  and  one^-third  of  an 
inch  wide,  so  that  a  very  slight  adenoid  hypertrophy 
at  this  time,  and  during  the  first  year,  will  cause 
obstruction.  This  space  in  a  year-old  child  will  have 
doubled  in  size.  If  the  adenoid  growth  is  large 
enough  to  cause  obstruction  there  will  be  mouth- 
breathing,  which  causes  snoring  at  night.  Most  chil- 
dren that  breathe  through  the  mouth  or  snore  will 
be  found  to  have  adenoids  or  enlarged  tonsils.  In 
cases  of  long  standing  the  facial  appearance  is  un- 
mistakable. It  is  characterized  by  the  open  mouth, 
drawn  expression,  small  thin  nose,  and  vacant  eye, 
which  give  the  child  a  stupid  look.  The  hearing  is 
frequently  impaired.  Kyle  says  ninety  per  cent  of 
all  adenoid  cases  are  accompanied  by  some  degree  of 
deafness.  There  is  difficulty  in  blowing  the  nose,  and 
occasionally  severe  nosebleed. 

It  is  said  adenoids  may  be  the  cause  of  bed-wetting, 
and  in  fact  cases  of  bed-wetting  have  been  cured  by 
the  removal  of  the  adenoids. 

Another  symptom  may  be  the  nasal  twang  to  the 
voice,  and  speech  is  sometimes  impaired.     Children 


THE  CHILD  111 

with  adenoids  are  particularly  susceptible  to  diph- 
theria, scarlet  fever,  influenza,  and  other  contagious 
diseases,  and  when  they  are  attacked  the  case  is  apt 
to  be  more  severe  than  with  children  free  from  these 
obstructions.  Any,  or  all,  of  the  symptoms  enum- 
erated may  be  present  in  cases  of  adenoids. 

The  treatment  is  complete  removal  of  the  adenoids ; 
this  is  a  slight  operation  and  is  without  danger. 
Local  applications,  gargles,  and  sprays  are  of  no 
use  in  the  treatment  of  this  condition. 


ENLARGED  TONSILS 

Chronically  enlarged  tonsils  are  quite  frequent 
among  children,  although  not  nearly  so  common  as 
adenoids.  They  are  usually  associated  with  adenoids, 
and  adenoids  may  be  caused  by  enlarged  tonsils. 
The  symptoms  we  get  in  cases  of  adenoids  alone  are 
aggravated  by  the  presence  of  enlarged  tonsils.  Chil- 
dren with  enlarged  tonsils  are  subject  to  frequent 
attacks  of  sore  throat  and  tonsilitis,  and  are  more 
apt  to  contract  the  contagious  diseases,  such  as  pneu- 
monia, diphtheria,  scarlet  fever,  etc. 

Medical  treatment  is  of  no  avail  in  these  cases. 
The  tonsils  should  be  removed.  The  operation  is 
practically  without  danger  when  performed  by  a 
skilful  operator,  and  the  relief  it  affords  is  most 
striking. 

Parents  feel  well  repaid  for  the  anxiety  caused  by 


112  THE  CHILD 

the  thought  of  an  operation,  as  after  it  is  over  they 
realize  that  the  health  of  the  child  depended  upon  it. 


OTITIS  MEDIA  OR  EARACHE 

This  is  a  very  common  affection  during  infancy 
and  childhood.  It  usually  follows  some  inflammatory 
condition  of  the  throat,  such  as  appears  with  infectious 
diseases  like  measles,  scarlet  fever,  diphtheria,  ton- 
silitis,  influenza,  or  even  a  common  cold  in  the  head. 
This  inflammation  may  sometimes  occur  in  apparently 
healthy  children. 

The  two  most  common  symptoms  are  fever  and 
pain,  which  make  an  infant  restless  and  peevish 
during  the  day  and  wakeful  at  night,  causing  it  to 
nurse  poorly  and  to  show  tenderness  about  the  ear 
on  the  affected  side.  In  very  severe  cases  the  child 
may  scream  with  pain  if  the  ear  is  touched.  The 
temperature  varies  from  100°  F.  to  102°  F. 

In  the  majority  of  cases  during  infancy  pain  is 
only  evidenced  by  crying,  but  older  children  will  put 
the  hand  to  the  painful  ear. 

Inflammation  of  the  internal  ear  may  be  catarrhal 
or  suppurative.  Catarrhal  inflammation  usually  sub- 
sides in  a  day  or  two,  under  proper  treatment.  Where 
the  fever  or  pain  continues  for  more  than  twenty-four 
hours  suppuration  has  probably  occurred,  and  the 
condition  is  best  relieved  by  a  slight  operation  to 
remove  the  pressure  on  the  drum  membrajXQ, 


THE  CHILD 


113 


Not  infrequently  the  drum  membrane  will  rupture 
of  itself,  and  this  will  be  followed  by  a  discharge  into 
the  canal  of  the  ear. 

When  otitis,  or  earache,  occurs  put  the  child  to  bed, 
wrap  it  up  tightly  in  a  sheet  or 
blanket,  place  a  basin,  protected  by 
a  towel,  under  its  head,  and  irrigate 
the  affected  ear  with  a  douche — given 
from  an  ordinary  fountain  syringe — 
of  water  heated  to  a  temperature  of 
110°  P.  One  or  two  pints  of  water 
should  be  used,  the  douche  bag  should 
not  be  held  more  than  two  feet  above 
the  child's  head,  and  the  tip  of  the 
syringe  should  be  placed  about  a 
quarter  of  an  inch  from  the  opening 
to  the  ear.  This  douche  may  be  given 
every  hour  until  the  pain  subsides 
or  the  physician  arrives. 

Dry  heat  is  also  an  excellent  means  of  relieving 
the  pain  of  earache.  This  may  be  applied  by  means 
of  a  hot  salt  bag,  which  is  made  by  sewing  together 
two  pieces  of  muslin  five  inches  by  three  inches  long, 
filling  half  full  with  salt,  heating  in  the  oven,  and 
binding  over  the  ear;  or  by  filling  the  finger  of  an 
old  glove  with  hot  salt  and  placing  the  tip  in  the  ear. 
The  salt  retains  the  heat  for  a  long  time.  Older 
children  can  rest  the  head  on  a  hot  water-bag. 
Never  put  laudanum  or  oil  in  the  ear  for  ear- 
ache. 

In  giving  the  douche  an  assistant  will  be  necessary 


Soft  Rubber 
Ear- Syringe. 


114  THE  CHILD 

to  steady  the  child's  head,  as  it  is  sure  to  struggle 
and  resist  the  treatment. 


HEADACHES 

In  babies  and  little  children  headaches  rarely  occur 
except  when  there  is  disease  of  the  brain;  but  in 
older  children  they  are  not  infrequent  and  may  be 
due  to  a  variety  of  causes,  the  most  frequent  of 
which  is  the  absorption  of  toxins  from  the  intestines 
as  a  result  of  putrefactive  changes,  chronic  indiges- 
tion, and  constipation.  They  are  not  infrequent  from 
breathing  impure  air  in  poorly  ventilated  rooms. 
Other  common  causes,  especially  in  children  from 
nine  to  fifteen,  are  malnutrition  and  angemia,  and 
headaches  are  also  often  seen  in  children  who  have 
been  advanced  too  rapidly  in  their  studies.    . 

Many  children  at  the  school  age  suffer  from  head- 
aches due  to  eye  strain,  from  errors  of  refraction, 
strabismus,  or  other  abnormality  of  the  eyes.  (These 
cases  will  need  to  be  fitted  for  glasses.)  Again, 
there  may  be  growths  in  the  throat,  such  as  adenoids, 
or  growths  in  the  nose  which  require  removal,  or  a 
chronic  catarrhal  condition  in  the  nose,  causing  stop- 
page. Otitis  media  or  foreign  bodies  in  the  ear  may 
be  the  cause  of  headache. 

Headaches  may  be  of  nervous  origin,  such  as 
are  seen  in  epilepsy,  hysteria,  or  tumor  of  the 
brain. 


THE  CHILD  115 

In  girls,  when  menstruation  is  difificult  or  delayed, 
headaches  sometimes  occur. 

The  treatment  for  headaches  consists  in  finding 
out  the  causative  factor  producing  them  and  treating 
this,  as  has  elsewhere  been  described.  For  the  im- 
mediate relief  of  the  pain,  cloths  dampened  with  cold 
water  may  be  bound  about  the  head,  or  an  ice-bag 
applied,  a  hot  foot-bath  or  mustard  foot-bath  given, 
and  a  glass  of  citrate  of  magnesia  water  or  a  dose  of 
castor-oil  and  two  grains  of  phenacetin. 


COUGH 

A  cough  in  an  infant  or  young  child,  when  not 
due  to  whooping-cough,  is  invariably  the  result  of 
some  abnormal  condition  connected  with  the  respira- 
tory tract;  either  disease  of  the  inner  surface  of  the 
nose,  throat,  or  bronchial  tubes,  or  some  disease  affect- 
ing the  lungs  or  pleura.  One  of  the  commonest 
causes  of  cough  at  night  is  the  presence  of  enlarged 
tonsils  or  adenoids,  relief  from  which  may  be  quickly 
obtained  by  means  of  a  slight  operation. 

We  not  infrequently  hear  of  the  *'  nervous  cough," 
the  **  stomach  cough,"  the  *'  liver  cough,"  but  these 
exist  only  in  the  minds  of  the  inexperienced. 

In  older  children  who  have  heart  disease  there 
may  be  a  dry  hard  cough  due  to  pulmonary  conges- 
tion, and  cough  may  be  one  of  the  manifestations 
of  hysteria  in  children  in  the  teens,  but  this,  too,  is 


116  THE  CHILD 

usually  due  to  an  abnormal  condition  of  the  respira- 
tory tract. 

CROUP 

This   may   be    either  a   catarrhal   or  membranous 
variety.     Catarrhal  croup  is  induced  by  catarrhal  in- 


Holt  Croup  Kettle. 

flammation  of  the  larynx,  while  membranous  or  diph- 
theritic croup  is  due  to  membranous  inflammation  of 
the  larynx. 

Catarrhal  croup  may  come  on  gradually,  following 
a  cold  in  the  head  or  tonsilitis  after  a  period  of  two 
or  three  days,  with  a  slight  fever  or  indisposition; 
the  voice  becomes  more  and  more  husky  until  it  may 


THE  CHILD  117 

be  difficult  for  the  child  to  speak  much  above  a  whis- 
per. The  cough  is  very  hoarse,  hollow,  and  barking, 
and  the  breathing,  in  croup,  is  so  loud  that  it  can 
frequently  be  heard  for  some  distance. 

A  child  may  be  put  to  bed  with  only  a  slight  cold 
or  cough,  or  be  apparently  well,  when  suddenly,  after 
sleeping  quietly  for  a  time,  it  will  sit  up  in  bed,  gasp 
for  breath,  and,  after  an  attack  of  loud,  hollow  cough- 
ing, will  break  out  into  perspiration. 

At  the  onset  of  croup  the  child  should  be  given  a 
teaspoonful  of  syrup  of  ipecac,  and  at  the  end  of  a 
quarter  of  an  hour,  if  vomiting  has  not  occurred, 
another  teaspoonful  can  be  given.  The  patient  should 
of  course  be  isolated  until  a  definite  diagnosis  has 
been  made.  A  dose  of  casfor-oil,  a  cold  compress 
applied  to  the  neck,  and  steam  inhalations  by  means 
of  a  croup  kettle  under  a  tent  made  from  a  sheet 
spread  over  the  crib,  are  all  valuable  treatments.  The 
fumes  from  menthol  crystals  heated  in  a  metal  pan 
over  a  flame  are  £llso  of  service. 

Membranous  or  diphtheritic  croup  is  one  of  the 
most  serious  affections  with  which  we  have  to  deal. 
Its  onset  is  very  much  like  that  of  catarrhal  croup, 
except  that  it  is  more  gradual  and  that  the  breathing 
becomes  more  and  more  difficult.  A  mother  cannot 
tell  whether  the  child  has  catarrhal  or  diphtheritic 
croup,  unless  diphtheria  is  known  to  be  present,  so 
she  should  take  no  chances,  but  send  for  a  doctor  at 
once,  as,  if  the  case  is  diphtheritic,  skilled  treatment 
obtained  in  time  will  probably  be  the  means  of  saving 
the  patient's  life. 


118  THE  CHILD 

BRONCHITIS 

Bronchitis  is  usually  due  to  cold  or  exposure  and 
should  be  looked  upon  as  a  serious  affection  when  it 
occurs  in  young  or  delicate  infants,  as  it  is  an  easy 
matter  for  the  inflammation  of  the  large  bronchial 
tubes  to  extend  to  the  smaller  ones,  and  so  to  the 
lungs,  causing  broncho-pneumonia. 

Bronchitis  may  come  on,  suddenly  or  gradually, 
from  the  extension  of  inflammation  to  the  bronchial 
tubes,  from  a  cold  in  the  head,  or  from  laryngitis. 
Its  presence  is  evidenced  by  a  cough,  increased,  and, 
in  some  cases,  slightly  labored  breathing,  a  ''  rattling  '' 
in  the  chest,  and  fever.  Some  bronchitis  is  almost 
always  present  with  measles,  and  it  may  be  a  com- 
plication of  some  other  diseases. 

If  seen  early,  an  attack  can  usually  be  cured  in 
a  short  time  by  counter  irritation  upon  the  chest  wall 
in  the  shape  of  a  mustard  paste, — one  part  mustard 
to  four  parts  of  flour, — applied  to  the  chest  for  twenty 
minutes  every  four  hours;  or,  in  mild  cases,  three 
times  a  day.  This,  with  proper  internal  medication, 
and  warm  moist  air  produced  by  steam  from  a  croup 
kettle,  will  generally  be  found  effectual. 

Children  with  bronchitis  should  never  be  loaded  with 
heavy  clothing  or  pads.  The  underclothing  should  be 
of  wool,  loose  and  comfortable.  Poultices  and  patent 
cough  syrups  must  never  be  used. 

In  mild  attacks  the  chest  should  be  thoroughly 
rubbed  with  camphorated  oil  twice  a  day  in  place 
of  the  mustard  paste. 


THE  CHILD  119 

PNEUMONIA 

The  lungs  are  more  frequently  the  seat  of  organic 
disease  in  infancy  and  early  childhood  than  any 
other  organs  of  the  body.  Pneumonia,  an  inflamma- 
tion of  the  lungs,  is  common  as  a  primary  disease 
and  as  a  complication  of  the  acute  infectious  diseases 
comes  first  on  the  list. 

There  are  two  common  varieties  of  pneumonia  in 
infancy  and  childhood,  lobar  and  broncho-pneumonia. 

Lobar  pneumonia  is  usually  a  primary  disease. 
The  onset  is  sudden,  not  infrequently  with  a  chill  or 
chilly  sensations,  vomiting,  or,  in  some  cases,  a  con- 
vulsion. The  temperature  is  high,  from  103°  F.  to 
105°  F.,  the  respirations  are  labored  and  from  forty 
to  sixty  to  the  minute,  the  face  is  flushed,  and  there 
is  prostration.  Lobar  pneumonia  when  uncompli- 
cated may  last  from  three  to  eleven  days.  Ordi- 
narily, however,  the  crisis  comes  on  the  fifth  or  seventh 
day,  when  the  temperature  drops  to  normal,  all  symp- 
toms subside,  and  convalescence  takes  place. 

The  onset  of  broncho-pneumonia  is  usually  gradual. 
It  is  frequently  engrafted  upon,  or  is  a  complication 
of,  another  disease,  such  as  a  cold  in  the  head,  bron- 
chitis, measles,  diphtheria,  whooping-cough,  or  diar- 
rhoea. 

Broncho-pneumonia  attacks  principally  young  and 
delicate  infants ;  it  may  continue  for  weeks  or  months, 
but  ordinarily  lasts  from  two  to  four  weeks.  It  is 
a  much  more  serious  disease  than  lobar  pneumonia. 
While  the  fever  is  lower  in  broncho-pneumonia  than 


120-  THE  CHILD 

in  lobar  pneumonia,  being  from  101°  to  102°  or 
103°  F.,  there  are,  with  the  bronchial  form  of  the 
disease,  steady  wasting  of  the  body,  poor  appetite, 
and  lack  of  vitality. 

In  pneumonia  careful  nursing  is  as  important  as 
drugs.  The  patient  should  be  placed  in  a  large,  well- 
ventilated,  sunny  room  kept  at  a  temperature  of  from 
65°  to  70°  F. ;  the  diet  should  consist  of  milk  and 
broth,  and  for  young  infants  the  milk  must  be  well 
diluted. 

The  child  should  be  kept  quiet,  and  undisturbed 
by  visitors;  only  the  nurse  and  mother  should  be 
allowed  in  the  sick  room,  and,  preferably,  only  the 
nurse  for  most  of  the  time.  There  should  be  no  gas 
burning  in  the  room,  and  the  windows  should  be 
opened  night  and  night.  Every  half-hour  or  so  the 
child  should  be  turned  from  side  to  side,  but  other- 
wise disturbed  as  little  as  possible.  All  undercloth- 
ing should  be  light,  loose,  and  of  woolen  material. 

The  endeavor  should  be  made  to  make  the  child 
as  comfortable  as  possible,  in  order  that  it  may  con- 
serve its  every  ounce  of  strength  to  overcome  the 
disease. 


LYMPHATIC     GLANDS.     ACUTE     ENLARGEMENT 
OF  THE  GLANDS  OF  THE  NECK 

Swelling  of  the  glands  of  the  neck  is  quite  a 
common  occurrence  in  infancy  and  early  childhood, 
about  three-quarters  of  the  cases  occurring  in  those 


THE  CHILD  121 

under  two  years  of  age.  The  glands  back  of  the  jaw 
and  below  the  ear  and  jaw  become  suddenly  swollen 
from  the  size  of  a  hickory  nut  to  that  of  a  hen's  egg. 
There  is  fever,  and  the  glands  are  tender  and 
painful.  This  is  due  usually  to  an  infection  from  a 
sore  mouth,  decayed  tooth,  abrasion  in  the  mouth, 
tonsilitis,  or  any  other  diseased  or  inflammatory  con- 
dition of  the  mouth  or  throat.  It  may  also  be  due 
to  a  neighboring  lesion  of  the  skin.  These  glands 
sometimes  enlarge  very  rapidly  and  cause  consider- 
able alarm,  but  the  condition  is  not  dangerous.  p]ither 
the  swelling  and  enlargement  subsides  completely 
under  treatment,  or  goes  on  to  abscess  formation, 
when  incision  and  drainage,  will  bring  about  a  cure. 
At  the  first  appearance  of  swelling  of  the  glands 
the  child's  mouth  should  be  thoroughly  cleansed  with 
an  antiseptic  mouth-wash,  such  as  borolyptol,  and  if 
there  is  a  sore  throat  or  a  decayed  tooth  it  should 
receive  immediate  attention.  Over  the  swelling,  cold 
treatment  should  be  applied  in  the  shape  of  a  small 
ice-bag  or  cold  compress,  and  then  the  child  should 
be  seen  by  a  physician. 


GLANDS— CHRONIC  ENLARGEMENT 

Chronic  enlargement  of  the  glands  of  the  neck  is 
a  condition  not  infrequently  found  in  children.  It 
may  be  due  to  one  of  several  causes,  tuberculous  in- 
fection, syphilis,  infection  from  the  mouth — as  from 
adenoids  or  enlarged  tonsils — or  from  skin  diseases. 


122  THE  CHILD 

The  glands  at  the  angle  of,  and  underneath,  the 
jaw,  or  down 'the  side  of  the  neck,  may  be  enlarged 
from  the  size  of  a  pea  to  that  of  a  walnut,  feel  hard 
like  a  marble,  and  be  slightly  tender. 

Chronically  enlarged  glands  are  most  frequently 
seen  in  delicate,  malnourished  children.  Such  chil- 
dren require  careful  supervision  and  should  be  seen 
frequently  by  a  physician,  who  may  direct  their  feed- 
ing, outdoor  life,  and  medication. 


HAIR 

The  hair  of  young  children  should  not  be  allowed 
to  grow  too  long,  but  should  be  cut  at  regular  in- 
tervals. Long  hair  in  the  summer  makes  the  child 
unnecessarily  hot  about  the  neck,  and  on  that  account 
may  cause  fretfulness.  When  the  hair  is  short  it  is 
easier  to  care  for  and  the  head  is  more  easily  kept 
clean. 

Cutting  the  hair  makes  it  grow  in  stronger  and 
thicker,  and  results  in  a  more  luxuriant  growth  later 
in  life,  which,  in  the  case  of  a  woman,  adds  greatly 
to  her  beauty.  Even  older  children,  when  attacked 
with  a  prolonged  and  wasting  fever,  such  as  typhoid, 
should  have  their  hair  cut  to  prevent  its  falling  out. 

The  head  should  be  kept  clean  and  free  from  crusts 
in  order  to  promote  a  proper  growth  of  hair. 


THE  CHILD  123 

HEAD-LICE 

Children  may  become  infected  with  head-lice  from 
other  school  children,  from  servants,  or  from  public 
conveyances. 

The  treatment  is  to  cut  the  hair  short,  wash  the 
head  thoroughly  with  soap  and  warm  water,  and, 
after  it  has  dried,  a  solution  of  one  part  of  diluted 
acetic  acid  or  vinegar  to  six  parts  of  tincture  of  lark- 
spur and  six  parts  of  alcohol,  should  be  thoroughly 
rubbed  into  the  scalp,  and  a. cloth  dampened  with  this 
solution  tied  about  the  head  for  two  or  three  hours. 
This  should  be  repeated  for  several  days,  or  until  the 
lice  are  all  killed. 

Where  the  hair  is  long  it  need  not  necessarily  be 
cut,  but  may  be  parted  in  different  places  and  the 
remedy  thoroughly  rubb(*d  in.  To  remove  the  nits 
a  fine  tooth-comb  will  be  recjuired,  and  it  will  take 
longer  to  get  rid  of  them  than  when  the  hair  is  cut. 
Ordinary  kerosene  oil  may  be  used  when  the  acetic 
acid  and  larkspur  are  not  at  hand. 


MILK-CRUST  OR  SEBORRHCEIC  ECZEMA  OF  THE 
SCALP 

This  is  a  form  of  eczema  due  to  the  inflammation 
and  excessive  secretion  of  the  sebaceous  glands  of 
the  scalp-skin,  and  is  characterized  by  the  formation 
of  crusts  or  thick  layers  of  a  yellowish  or  discolored 
material.     This  condition  causes  itching  of  the  scalp, 


124  THE  CHILD 

and  gives  the  appearance  of  uncleanliness,  which, 
however,  is  not  the  case,  as  washing  with  soap  and 
water  has  little  effect  upon  it. 

Milk-crust  can  quickly  be  cured  by  the  use  of  a 
five  per  cent  salicylic  acid  ointment,  applied  morning 
and  night  on  soft  linen,  under  a  close-fitting  muslin 
cap,  to  be  worn  constantly. 

Before  the  treatment  is  begun  the  hair  should  be 
cut  short.  After  several  days  of  treatment  the  scalp 
material  will  have  softened  and  can  be  easily  washed 
off. 

CARE  OF  THE  SKIN 

An  infant's  skin  is  very  delicate,  and  to  insure  a 
healthy  condition  great  car^  is  required.  It  should 
be  kept  clean  and  dry,  and  this  can  be  accomplished 
by  a  daily  bath  of  plain  boiled  water,  using  only 
Castile  soap.  Then  it  should  be  thoroughly  dried  and 
all  the  folds  of  the  skin,  the  axilla,  groin,  and  geni- 
tals, well-powdered  with  equal  parts  of  starch  and 
zinc  oxide  powder. 

During  hot  weather,  sponging  with  tepid  wRter  will 
cleanse,  cool,  and  quiet  the  child  and  often  prevent 
prickly  heat,  scalding,  intertrigo,  or  eczema. 


PRICKLY  HEAT 

Prickly  heat  is  a  very  frequent  affection  in  infants 
and  young  children  during  hot  weather.  It  is 
due  to  the  heat  and  excessive  sweating. 


THE  CHILD  125 

An  eruption  consisting  of  very  small  light  red  or 
pink  papules  appears.  They  may  be  located  princi- 
pally on  the  neck,  chest,  back,  or  abdomen,  but  they 
also  frequently  cover  the  whole  body,  even  the  face. 
This  eruption  itches  and  causes  considerable  discom- 
fort. 

Prickly  heat,  in  most  cases,  is  the  result  of  wearing 
too  much  and  too  heavy  clothing.  Children  during 
the  warm  weather  should  be  dressed  in  thin,  loose, 
cotton  underwear. 

The  itching  of  prickly  heat  may  be  relieved  by 
frequent  bathing,  and,  after  the  bath,  sponging  off 
with  a  solution  of  bicarbonate  of  soda — a  tablespoon- 
ful  of  soda  to  a  quart  of  water — drying  without  fric- 
tion, and  dusting  the  skin  thoroughly  with  equal  parts 
of  starch  and  borated  talcum  powder. 


INTERTRIGO 

This  is  an  eczematous  inflammation  of  the  surface 
of  the  skin  about  the  buttocks,  anus,  groins,  and  inner 
surfaces  of  the  thighs.  The  skin  becomes  very  red, 
angry,  and  extremely  sore.  Intertrigo  occurs  as  the 
result  of  allowing  soiled  diapers  to  remain  on  the 
child. 

The  skin  is  very  delicate,  and  frequently  the  urine 
is  very  acid  and  causes  irritation  and  excoriation. 

The  care  in  these  cases  consists  of  changing  the 
diapers  as  soon  as  they  are  soiled,  and  washing  the 
parts  gently  with  Castile  soap  and  warm  water,  and, 


126  THE  CHILD 

after  careful  drying,  applying  with  old  linen  cloths 
either  Lassar's  paste  or  zinc  oxide  ointment  to  the 
excoriated  surface.  This  should  be  done  as  often  as 
the  parts  become  wet  or  soiled. 


HIVES 

This  is  quite  a  common  affection  in  children.  It 
is  characterized  by  the  sudden  appearance  of  an 
eruption  resembling  large  wheals  from  one-half  to  an 
inch,  or  larger,  in  diameter.  These  are  red,  smooth, 
flat,  and  firm. 

There  may  be  only  one  or  two  on  any  portion  of 
the  body,  but  sometimes  the  mucous  membrane 
of  the  mouth,  or  tongue,  or  nearly  the  whole  body, 
may  be  covered.  Intense  itching  always  accompanies 
this  affection.  The  rash  may  disappear  in  a  few 
hours  or  it  may  last  several  days. 

Hives  are  almost  invariably  caused  by  indigestion, 
due  to  indiscretion  in  diet.  Strawberries,  cheese,  fish, 
rich  cakes  or  pastries — and  occasionally  diphtheria 
antitoxin — may  bring  about  an  attack  of  hives.  To 
relieve  the  itching  frequent  bathing,  and  sponging 
with  a  strong  solution  of  bicarbonate  of  soda,  or  a 
soda  bath,  will  be  found  excellent.  A  dose  of  castor- 
oil,  or  citrate  of  magnesia  water,  and  a  salt-water 
enema  to  clear  the  bowels,  together  with  internal  med- 
icine and  a  restricted  diet,  will  speedily  effect  a  cure. 


THE  CHILD  127 

ECZEMA 

Eczema  is  an  inflammation  of  the  skin  very  com- 
monly met  with  in  infants  and  young  children.  It 
may  appear  on  any  part  of  the  body,  but  is  most 
frequently  seen  on  the  face,  forehead,  scalp,  buttocks, 
folds  of  the  skin,  or  where  two  surfaces  come  in 
contact,  such  as  flexor  surfaces  of  the  joints. 

The  skin  of  an  infant  is  very  delicate,  and  any 
local  irritation  is  a  fruitful  source  of  eczema.  Strong 
soaps,  excessive  perspiration,  liniments,  exposure  to 
cold  winds,  lack  of  cleanliness,  discharges  from  the 
nose  or  ear  are  productive  of  eczema.  Soiled  diapers 
left  too  long  without  changing  are  sure  to  produce 
eczema  of  the  buttocks. 

Eczema  is  very  frequently  caused  by  indigestion, 
especially  in  well-nourished  babies,  both  breast  and 
bottle  fed.  The  face  and  cheeks  become  bright  red 
and  scaly,  and  the  eczema  may  be  moist  and  angry 
looking. 

In  treating  a  case  of  eczema  the  cause  of  the  trouble 
must  first  be  removed,  whether  it  be  external  or 
internal.  If  the  disease  comes  from  indigestion  in 
breast-fed  babies  the  mother's  diet,  bowels,  and  exer- 
cise should  be  regulated  so  that  her  milk  will  be  suit- 
ably adapted  to  the  child.  In  bottle-fed  babies  a 
study  should  be  made  of  the  food  in  order  to  adapt 
it  to  their  digestive  capacity. 

In  treating  a  case  of  eczema  measures  should  be 
taken  to  prevent  the  child  from  scratching.  For  this 
purpose  a  splint  may  be  bandaged  over  the  elbow 


128 


THE  CHILD 


joints,  so  that  the  arms  cannot  be  flexed,  or  gloves 
may  be  worn ;  but  what  is  best  of  all  is  the  '  ^  Hand- 
I-Hold  "  *  babe  mits,  worn  as  shown  in  the  illustration. 


Hand-I-Hold  Babe  Mits  and  Method  of  Bandaging 
in  Eczema  of  Head  and  Face. 


These  consist  of  celluloid  balls  perforated  with 
holes,  which  are  tied  on  the  hands.  They  come  in 
different  sizes,  according  to  the  age  of  the  child, 
and  will  be  found  an  excellent  protection. 

***Hand-I-Hold"  babe  mits  are  made  by  R.  M.  Clark  and 
Company  of  246  Summer  St.,  Boston,  Mas§.   ^ 


THE  CHILD  129 

The  local  areas  of  eczema  should  be  kept  dry,  a 
suitable  ointment  applied,  and  the  part  bandaged. 

It  must  be  remembered,  however,  that  ointments, 
lotions,  or  powders  are  of  little  value  in  the  treatment 
of  this  condition  unless  they  are  used  in  connection 
with  dietetic  and  hygienic  measures,  and  internal 
medication  when  required. 


WARTS 

Warts  are  small  hard  or  horny  elevations  due  to  a 
hypertrophy  of  the  tw^o  layers  of  the  skin.  They  may 
be  few  or  numerous,  and  are  from  the  size  of  a  pin- 
head  to  half  an  inch  in  diameter.  They  may  appear 
on  any  portion  of  the  body,  but  are  commonly  seen 
on  the  hands  of  children. 

Warts  may  suddenly  appear,  attain  their  full  size 
rapidly,  and  as  quickly  disappear;  or  they  may 
remain  indefinitely. 

Painting  the  growths  with  the  juice  of  the  milkweed 
or  tincture  of  iodine  will  often  make  them  disappear. 
They  may  also  be  burned  out  with  strong  acids.  The 
quickest  w^ay  to  remove  these  troublesome  growths  is 
by  excision  with  the  knife,  by  snipping  them  off 
with  curved  scissors,  or  curetting  them  out  by  the 
roots.  Cocaine  or  freezing  may  be  employed  to  avoid 
all  pain,  but  operations  of  this  sort  are  not  always 
desirable,  and  should  not  be  employed  except  in  ex- 
treme cases. 


130  THE  CHILD 

STIES 

Sties  are  localized  inflammation  of  one  of  the  glands 
at  the  margin,  or  surrounding  tissue,  of  the  eyelid. 

They  may  indicate  general  ill  health,  and  are  fre- 
quently seen  associated  with  refractive  error  of  the 
eyes,  or  are  the  result  of  eye  strain.  Bacteria  gain 
entrance  at  the  root  of  the  eyelash  and  set  up  in- 
flammation. Before  suppuration  develops  abortive 
treatment  may  be  tried,  using  frequent  applications 
of  a  saturated  solution  of  boracic  acid  and  applying 
compresses  wet  with  the  same  solution  to  the  lids. 
Another  method  is  the  application  of  yellow  oxide 
of  mercury  ointment  to  the  lids.  Pain  and  swelling 
may  be  relieved  by  the  use  of  frequent  hot-water  com- 
presses. When  suppuration  appears  a  slight  incision 
will  be  necessary  to  effect  a  rapid  cure.  Children 
that  are  run  down  in  health  or  have  errors  of  re- 
fraction should  receive  appropriate  tonics  or  be  fitted 
for  glasses,  as  the  case  may  require. 


BOILS 

These  are  local  infections  underneath  the  skin. 
The  germs  gain  entrance  through  a  minute  abrasion, 
hair  follicle,  or  sebaceous  sweat  gland.  They  vary 
in  size  from  a  pea  to  that  of  an  almond.  They  occur 
most  frequently  upon  the  head,  face,  and  shoulders 
of  children  under  two  years  of  age.  Very  often  chil- 
dren with  boils  are  suffering  also  from  digestive  dis- 


THE  CHILD  131 

turbances,  but  not  necessarily.  After  one  boil  others 
usually  soon  appear.  This  is  because  the  pus  is 
carried  by  the  lymphatics,  or  escapes  on  the  surface 
and  is  spread  to  other  portions  of  the  skin,  causing 
further  infection  which  may  result  in  a  great  many 
boils. 

Boils  are  best  treated  by  opening  them  with  a  slight 
incision,  squeezing  out  and  removing  the  pus  with 
absorbent  cotton,  thoroughly  washing  the  whole  sur- 
rounding skin  with  soap  and  warm  water,  then  with 
alcohol,  painting  each  boil  with  tincture  of  iodine, 
and  applying  an  antiseptic  dressing  of  saturated  solu- 
tion of  boracic  acid.  Gauze  or  clean  linen  should 
be  soaked  in  the  solution  and  applied  to  the  affected 
surface,  then  bandaged  to  keep  it  in  place. 

This  dressing  should  be  kept  moist  with  the  boracic 
acid  solution.  Later  on,  when  scabs  have  formed,  a 
suitable  ointment  may  be  applied. 


IVY-POISONING 

Children  who  go  to  the  country  sometimes  become 
poisoned  with  the  poison-ivy.  This  may  affect  the 
hands,  face,  arms,  legs,  or  any  exposed  part  of  the 
body,  and  cause  intense  itching  and  burning,  with 
considerable  swelling,  redness,  and  pain.  The  parts 
affected  should  be  bathed  in  a  strong  solution  of  com- 
mon salt,  or  bicarbonate  of  soda.  Compresses  moist- 
ened with  one  of  these  solutions  should  be  applied  at 
frequent  intervals.     Dampened  clay  laid  on  the  sur- 


132  THE  CHILD 

face  is  also  of  value  and  affords  great  relief.  The 
fluid  extract  of  Grindelia  (one  part  to  ten  parts  of 
water)  is  highly  recommended  as  a  local  application. 


NETTLE-RASH 

This  is  another  troublesome  condition  that  is 
brought  about  by  contact  of  the  skin  with  the  nettle- 
weed.  It  produces  swelling  and  redness  of  the  skin, 
with  intense  burning  and  itching.  It  is  best  relieved 
by  frequent  bathing  and  applications  of  a  strong  solu- 
tion of  bicarbonate  of  soda. 


BURNS 

Burns  are  of  various  degrees  of  severity  and  re- 
quire treatment  accordingly.  Thus  we  have  severe 
sunburns,  burns  from  hot  metal  and  fire,  also  scalds 
from  steam,  hot  water,  etc. 

The  first  thing  to  do  for  every  burn  is  to  keep  the 
air  from  the  injured  part  and  thus  relieve  the  pain. 
For  this  purpose,  where  the  burn  is  of  the  first  degree, 
a  thick  paste  made  from  bicarbonate  of  soda  can  be 
used.  It  should  be  spread  over  the  burnt  skin;  this 
will  cool  the  burnt  surface  and  relieve  the  pain  and 
stinging. 

Where  the  burn  is  more  severe  or  extensive  equal 
parts  of  linseed  oil  and  lime-water  (carron  oil)  should 
be  liberally  applied,  and  the  part  covered  with  pieces 


THE  CHILD  133 

of  soft  old  linen ;  but  if  these  are  not  at  hand  sweet- 
oil  or  vaseline  may  be  used  instead  until  medical  aid 
arrives.  The  shock  from  severe  or  extensive  burns 
is  often  of  a  serious  nature  and  the  patient  requires 
internal  stimulation,  such  as  brandy,  whisky,  and 
aromatic  spirits  of  ammonia. 


FROST-BITE 

Frost-bite,  although  rather  rarely  seen,  does  occur 
sometimes  in  children,  and  mothers  should  know  what 
to  do  in  such  cases. 

The  thing  to  be  dreaded  is  the  partial  or  total  death 
of  the  tissues  whose  vitality  has  been  so  lowered  by 
the  cold.  Cases  of  frost-bite  should  be  handled  with 
the  utmost  care  if  gangrene  of  the  frozen  part  is  to 
be  avoided.  The  circulation  should  be  brought  back 
very  gradually  by  gently  rubbing  the  parts  affected 
with  snow,  or  immersing  them  in  ice-cold  water  and 
applying  friction.  This  treatment  should  be  applied 
in  a  cold  room,  and  the  patient  under  no  circum- 
stances allowed  near  a  fire  or  where  there  is  heat  of 
any  kind.  After  the  general  temperature  of  the  body 
and  of  the  frozen  part  has  become  about  normal, 
alcohol  and  water,  spirits  of  camphor,  or  camphorated 
oil,  should  be  applied  with  friction,  and  the  affected 
parts  elevated  and  covered  with  cotton.  Stimulating 
drinks  may  now  be  given  cautiously  and  the  air  of 
the  room  gradually  warmed. 


134  THE  CHILD 

CHAPPED  HANDS  OR  LIPS 

Chapped  hands  are  the  result  of  prolonged  and 
continuous  exposure  of  the  parts  to  wet  and  cold. 
To  relieve  this  condition  keep  the  hands  warmly  cov- 
ered with  gloves  or  woolen  mittens  in  the  winter,  and 
never  use  cold  water,  strong  antiseptics,  strong  soaps, 
or  washing-powders. 

Ointment  consisting  of  one  part  of  Balsam  of  Peru 
to  seven  parts  of  lard  should  be  applied  to  the  lips 
and  hands  several  times  a  day,  alternating  with 
glycerine,  and  where  the  cracks  in  the  skin  or  mucous 
membrane  are  deep  they  may  be  painted  with  col- 
lodion. 

CHILBLAINS 

Chilblains  may  result  after  a  moderate  exposure 
to  dry  cold  or  cold  damp  air,  followed  by  a  sudden 
warming  at  the  fire.  This  is  especially  the  case  in 
children  and  those  with  feeble  circulation.  A  chil- 
blain may  appear  on  the  nose,  ears,  or  lips,  but 
the  commonest  seat  of  chilblains  is  the  fingers  or 
toes. 

The  symptoms  are  swelling,  redness,  heat,  and  itch- 
ing of  the  part.  These  symptoms  may  become  very 
annoying,  and  in  some  cases  serious  if  neglected. 
Children  who  have  been  once  attacked  are  liable  to 
recurrences,  so  that  they  should  always  during  cold 
weather  wear  warm  woolen  gloves  and  socks,  and 
warm  mufflers  for  the  ears  and  face.     Measures  should 


THE  CHILD  135 

be  taken  to  improve  the  eirculaticn  by  means  of  mas- 
sage and  tonies  After  exposure  to  cold  any  sudden 
approach  to  the  fire  should  be  avoided.  Mild,  acute 
chilblains  may  be  rubbed  gently  with  snow,  and  then 
ice-cold  water  may  be  applied.  This  treatment,  with 
rest  and  a  soothing  lotion,  such  as  lead  and  opium 
wash,  will  usually  effect  a  cure,  but  in  the  more 
chronic  or  severe  cases  stimulating  liniments  and 
other  measures  will  be  necessary. 

Kecently  the  following  treatment  has  been  recom- 
mended by  a  French  physician:  the  affected  parts 
are  bathed  morning  and  evening  in  a  decoction  of 
walnut  leaves,  followed  by  friction  with  spirits  of 
camphor,  and  after  this  the  parts  are  dusted  with  a 
powder  consisting  of  one  part  of  bismuth  salicylate 
to  six  parts  of  pulverized  starch.  The  following  pre- 
scription, to  be  applied  at  night,  is  also  advocated: 
Glycerine  and  rose  water,  an  ounce  and  a  half  of  each, 
to  which  is  added  fifteen  grains  of  tannin. 


STINGS  AND  BITES 

The  stings  of  nearly  all  small  insects  are  acid, 
depending  for  their  acidity  upon  formic  acid.  Rem- 
edies used  for  the  relief  of  bee  stings,  mosquito,  fly, 
spider,  bug,  or  other  insect  bites  may  be  mud  or  damp 
clay,  also  applications  of  a  thick  solution  of  bicar- 
bomate  of  soda,  or  ammonia  water  upon  the  affected 
part.     Sometimes   the   extreme   itching  of  mosquito 


136  THE  CHILD 

bites  can  be  relieved  by  sponging  the  part  with  a 
1  to  100  solution  of  carbolic  acid,  and  this  treatment 
has  the  advantage  of  quieting  the  itching  and  keeping 
the  mosquitoes  away.  Stings  may  also  be  cooled  and 
relieved  by  the  use  of  vinegar,  pure  or  diluted.  Pure 
hydrogen  peroxide  applied  immediately  upon  a  sting 
or  bite  is  a  valuable  remedy.  Extract  of  ipecac 
powder  made  into  a  paste  and  applied  to  bee  stings 
is  also  of  service. 

In  case  of  snake  bites  a  tight  bandage  or  ligature 
should  be  placed  at  once  just  above  the  bite,  between 
it  and  the  heart,  to  prevent  the  spread  of  the  poison, 
and  spirits  of  ammonia,  aromatic  spirits  of  ammonia, 
brandy  or  whisky  should  be  given  internally  as  stim- 
ulants. The  drug  of  greatest  value  is  permanganate 
of  potash,  applied  externally  and  also  injected  into 
the  area  of  the  wound.  For  this  last  treatment  a 
physician  will  be  required.  An  antitoxin  is  also  used 
in  snake  bite.  It  has  been  shown  experimentally 
that  the  bile  taken  from  a  poisonous  snake  is  a  power- 
ful antidote  for  the  snake  bite,  so  that  after  a  snake 
bite,  if  it  is  possible  to  kill  the  snake,  all  its  bile 
should  be  injected  near  the  wound. 

Bites  from  animals,  such  as  dogs  or  cats,  are  rarely 
of  a  serious  nature.  In  the  many  persons  who  are 
bitten  by  dogs  and  cats  each  year  it  is,  fortunately, 
rare  for  hydrophobia  to  develop,  since  it  can  only 
develop  from  the  bite  of  a  mad  dog,  and  happily 
dogs  rarely  go  mad.  But,  though  the  ordinary  bite 
is  usually  a  trifling  matter,  every  precaution  should 


THE  CHILD  137 

be  taken  to  guard  against  the  possibility  of  hydro- 
phobia in  the  child. 

A  bite  should  be  immediately  cleansed  with  hydro- 
gen peroxide  and  cauterized  with  a  small  pointed 
red-hot  iron;  or  with  caustic  potash,  applied  to  the 
wound  after  the  surrounding  tissue  has  been  pro- 
tected by  adhesive  plaster  with  a  hole  cut  in  it  the 
size  of  the  wound.  After  it  is  believed  that  the  caus- 
tic potash  has  burned  deep  enough,  it  should  be 
washed  off  with  diluted  vinegar.  Then  a  solution 
of  carbolic  acid  (one  teaspoon ful  to  a  pint  of  water) 
should  be  applied  to  the  wound  in  the  shape  of  a 
wet  dressing,  using  gauze  or  clean  linen. 

The  early  destruction  of  the  wounded  tissue  before 
symptoms  of  the  disease  appear  will  usually  prevent 
its  occurrence.  Further  treatment,  if  necessary,  will 
be  prescribed  by  the  physician. 

In  every  case  of  bite,  if  the  animal  is  suspected  of 
rabies  it  should  be  kept  alive  and  under  observation, 
as  by  killing  the  animal  doubt  as  to  whether  it  was 
mad  or  not  will  be  left  in  the  mind  and  cause  anxiety 
for  months,  or  even  years,  on  the  part  of  the  person 
bitten.  If  the  animal  is  really  mad  it  will  only  live 
a  short  time. 

Licking  may  be  a  serious  menace  and  make  neces- 
sary the  same  treatment  used  for  a  bite.  A  dog  or 
cat  should  never  be  allowed  to  lick  an  open  wound, 
abrasion  of  the  skin,  or  a  sore  on  a  child.  I  have 
known  grave  anxiety  to  result  from  licking  by  a  dog. 
I  have  now  in  mind  a  child  who  was  sent  for  treat- 
ment to  the  Pasteur  Institute  because  a  thoughtless 


138  THE  CHILD 

maid  allowed  a  pet  dog  to  lick  a  sore  on  the  child's 
leg.  The  dog  was  attacked  with  rabies  and  bit  a  cat, 
which  went  mad. 

SPRAINS 

Sprains  commonly  occur  upon  the  ankle,  wrist, 
knee,  and  finger  joints.  They  are  due  to  a  fall,  or 
wrenching  of  the  part,  causing  severe  stretching,  tear- 
ing, or  complete  rupture  of  the  ligaments.  This  is 
accompanied  by  great  pain  and  followed  by  swelling. 
Sprains  are  often  of  a  serious  nature,  and  to  effect 
a  cure  requires  careful  treatment  and  prolonged  rest, 
with  immobilization. 

The  first  thing  to  do  in  case  of  a  sprain  of  the 
lower  extremity  is  to  put  the  patient  to  bed,  where 
the  affected  part  can  be  kept  at  rest,  and  hot  com- 
presses applied.  These  consist  of  cloths  wrung  out 
of  water  heated  to  a  temperature  of  110°  F.  When 
the  upper  extremity  is  involved  hot  compresses  should 
be  applied  and  the  arm  kept  in  a  sling.  When  hot 
water  is  not  immediately  obtainable  a  cold  compress 
may  be  used.  Further  treatment  should  be  prescribed 
by  the  physician  in  charge ;  but  when  in  the  country 
or  far  from  a  physician,  witch-hazel  or  tincture  of 
arnica  should  be  thoroughly  applied,  with  gentle  fric- 
tion to  the  part.  Another  remedy,  which  is  very 
serviceable  and  much  used  in  the  country,  is  clay 
moistened  with  warm  vinegar  and  applied  as  a  poul- 
tice over  the  sprain. 


THE  CHILD  139 

TOOTHACHE 

If,  as  has  been  elsewhere  indicated,  the  teeth  receive 
proper  care  and  attention  toothache  should  rarely 
occur. 

By  the  habitual  use  of  a  soft  tooth-brush  and  tooth- 
powder,  combined  with  regular  visits  to  the  dentist 
twice  a  year,  and  restriction  in  the  matter  of  sweets, 
this  terror  of  childhood  may  be  practically  done  away 
with.  When  these  precautions  have  been  neglected 
and  a  cavity  has  formed  with  resulting  toothache  a 
small  amount  of  absorbent  cotton  may  be  soaked  in 
oil  of  cloves  and  placed  in  the  decayed  tooth.  If  oil 
of  cloves  is  not  at  hand  the  cotton  may  be  soaked  in 
chloroform,  or  equal  parts  t)f  tincture  of  iodine  and 
tincture  of  aconite.  Toothache  may  result  from  sore- 
ness of  the  gums  when  there  is  no  cavity,  in  which 
case  the  gums  about  the  tooth  should  be  painted  with 
equal  parts  of  tincture  of  iodine  and  tincture  of 
aconite. 

When  cavities  exist  an  early  visit  to  the  dentist  is 
in  order,  so  that  the  trouble  can  be  permanently 
arrested. 

BRUISES 

Bruises  are  of  frequent  occurrence  in  childhood 
and  should  receive  prompt  attention.  The  affected 
part  should  be  placed  in  water  at  a  temperature  of 
110°  F.,  or  as  hot  as  can  be  borne  with  comfort  by 
the  hand. 


140  THE  CHILD 

After  the  pain  has  subsided  a  wet  dressing  of 
boracic  acid  solution  or  witch-hazel  should  be  applied. 
Severe  bruises  require  the  attention  of  a  physician. 


CUTS 

Cuts  should  be  washed  and  cleansed  with  hydrogen 
peroxide,  a  wet  dressing  of  gauze  dipped  in  boracic 
acid  solution  applied,  and  the  part  snugly  bandaged. 
When  the  cut  is  deep  or  extensive  and  there  is  much 
bleeding  the  bleeding  can  be  stopped  by  applying  a 
pad  made  up  of  many  thicknesses  of  gauze,  and  ban- 
daging tightly.  Large  cuts,  or  cuts  on  the  face  or 
head,  require  stitches,  which  demands  the  services  of 
a  physician  at  once. 


NOSEBLEED 

Nosebleed  in  infants  is  of  rare  occurrence  except 
in  connection  with  a  systemic  disease,  but  in  children 
over  three  years,  and  especially  at  the  school  age,  it 
is  not  so  infrequent. 

Nosebleed  may  be  due  to  traumatism,  or  occur  in 
children  that  are  confined  in  close,  warm  rooms;  it 
is  sometimes  a  result  of  catarrh  of  the  nose,  with 
ulcers  or  erosions  on  the  septum.  Sometimes  it  comes 
from  adenoid  vegetations.  Foreign  bodies  causing 
erosions  will  sometimes  produce  nosebleed.  It  may 
also  occur  in  infectious  diseases,  such  as  pneumonia 


THE  CHILD  141 

and  typhoid  fever,  in  certain  blood  diseases,  in  scurvy 
and  in  heart  disease,  and  with  girls  at  the  time  of 
puberty.  The  commonest  cause  of  nosebleed  is  the 
formation  of  little  ulcers  or  erosions  of  the  mucous 
membranes  of  the  septum,  produced  by  picking  the 
nose.  These  are  especially  apt  to  occur  in  delicate 
children. 

Bleeding  from  one  nostril  is  due  either  to  the 
presence  of  a  foreign  body  or  to  nasal  diphtheria. 
No  matter  what  the  cause,  the  treatment  for  immedi- 
ate relief  is  to  place  the  patient  in  an  upright  position, 
grasp  the  nose  tightly  with  the  thumb  and  forefinger 
just  in  front  of  the  nasal  bones,  and  hold  it  for  from 
fifteen  minutes  to  half  an  hour;  then  apply  ice  cloths, 
and  prevent  picking  or  blowing  of  the  nose. 

Vinegar  or  lemon  juice  may  be  sprayed  into  the 
nose,  or  a  piece  of  bacon  fat,  cut  to  fit  and  placed  in 
the  nose,  may  stop  the  bleeding  when  other  remedies 
have  failed.  If  the  bleeding  is  severe  or  repeated  a 
physician  should  be  consulted  at  once. 

The  prophylactic  treatment  is  to  eliminate  the  above 
mentioned  causes  by  appropriate  measures  and  so 
insure  a  permanent  cure. 


FOREIGN  BODIES  IN  THE  EAR  OR  NOSE 

Children  at  the  runabout  age  frequently  put  all 
sorts  of  small  things  into  their  nose  or  ears;  indeed, 
some  seem  to  have  a  positive  mania  for  it.  I  have 
taken  beans,  peas,  small  buttons,  shoe-buttons,  small 


142  THE  CHILD 

bells,  pieces  of  coal,  small  stones,  and  a  variety  of 
other  little  objects  from  the  ears  and  noses  of  children. 

As  soon  as  it  is  discovered  that  the  child  has  put 
something  into  its  ear  or  nose  it  should  be  taken  at 
once  to  the  doctor.  No  attempt  should  be  made  by 
the  mother  or  nurse  to  remove  the  foreign  body, 
as  usually  the  effort  only  succeeds  in  pushing  the 
object  in  farther,  and  the  nose  or  ear  may  be  seriously 
injured  by  an  attempt  to  relieve  the  situation  with  a 
button-hook  or  a  hairpin — the  instruments  generally 
brought  into  use  for  this  purpose. 

Children  who  repeat  this  offense  should  be  thor- 
oughly punished  each  time  it  occurs. 


FOREIGN  BODIES  SWALLOWED 

As  soon  as  children  begin  to  creep  about  the  floor, 
and  also  at  the  runabout  age,  the  mouth  becomes  the 
receptacle  for  all  manner  of  small  bodies,  such  as 
coins,  rings,  marbles,  pins,  safety-pins,  and  other 
small  objects.  These  are  afterward  swallowed,  and 
later  passed  through  the  bowels  without  harm  to  the 
child,  in  the  majority  of  cases. 

When  a  foreign  body  has  been  swallowed  the  child 
should  be  fed  upon  bread  and  milk  and  mashed  pota- 
toes, as  this  diet  will  form  an  incrustation  around  the 
foreign  substance,  and  it  will  become  buried  in  a  mass 
of  food  and  so  pass  more  easily  and  with  less  danger 
through  the  stomach  and  bowels.  No  cathartic  should 
ever  be  given  to  hasten  the  passage,  as  such  measures 


THE  CHILD  143 

will  increase  the  peristaltic  action  of  the  bowels  and 
so  increase  the  danger  of  impaction  of  the  foreign 
body. 

CARE  OF  THE  GENITAL  ORGANS 

Cleanliness  of  the  genitals  and  proper  attention  to 
their  care  is  often  neglected  in  infants  and  young 
children  until  harm  results  from  reflex  irritation. 
It  is  most  important  that  the  genitals,  both  of  boys 
and  girls,  be  thoroughly  cleansed  every  day  with 
Castile  soap  and  warm  water  when  the  bath  is  given. 
This  is  especially  necessary  in  the  case  of  boys.  If 
the  foreskin  is  long  and  the  opening  small  and  con- 
stricted circumcision  should  always  be  performed.  If 
it  is  not  long  but  only  adherent,  the  adhesions  should 
be  broken  up  and  the  foreskin  retracted  and  the  organ 
washed  with  soap  and  water  and  thoroughly  smeared 
with  vaseline  every  day  until  healed.  A  very  large 
percentage  of  male  children  are  better  off  for  circum- 
cision. With  a  long  foreskin  it  is  impossible  to  keep 
the  organ  clean.  Smegma  collects  back  of  the  glands, 
adhesions  form,  with  resulting  irritation,  which  fre- 
quently causes  bed-wetting  and  masturbation,  ner- 
vousness, poor  sleep,  and  general  ill  health. 


TRAINING  TO  A  PROPER  CONTROL  OF  BOWELS 
AND  BLADDER 

A  great  deal  can  be  done  in  the  matter  of  teaching 
a  child  while  young  a  proper  control  over  the  bowels 


144  THE  CHILD 

and  bladder.  It  is  often  possible  to  train  an  infant 
by  the  third  or  fourth  month  to  have  its  movements 
from  the  bowels  when  placed  on  a  small  chamber. 
This  should  be  done  soon  after  nursing.  If  a  child 
can  be  taught  this  control  it  not  only  saves  much  work 
in  the  washing  of  diapers  but  also  insures  a  movement 
at  a  regular  time. 

By  the  end  of  the  first  year,  and  in  some  cases 
earlier,  almost  all  children  can  be  taught  to  control 
the  bladder  and  make  known  when  they  wish  to  empty 
it.  By  the  time  a  child  is  two,  or  two  and  a  half, 
years  of  age  it  should  be  able  to  hold  its  Water  all 
night  if  taken  up  and  placed  on  the  chamber  at  ten 
or  eleven  (p.m.)  o'clock.  Giving  children  liquids  at 
night  should  be  avoided,  as  this  is  responsible  for 
much  bed-wetting. 

The  importance  of  creating  these  habits  while  the 
child  is  young  is  very  great,  as  it  is  essential  to  health 
later  in  life  and  lessens  to  a  marked  degree  the  care 
and  trouble  attendant  upon  infancy. 


RETENTION  OF  URINE 

Several  causes  may  prevent  a  child  from  passing 
its  urine.  In  girls  it  may  be  from  vaginitis  or  that 
highly  acid  urine  irritates  the  parts,  while  in  boys 
there  may  be  highly  acid  urine,  or  a  long  foreskin 
which  has  become  swollen,  so  that  the  small  opening 
is  almost  or  entirely  closed.  High  fever  is  sometimes 
accompanied  by  retention  of  urine,  and  in  some  cases 


THE  CHILD  145 

a  cold,  or  sudden  chilling  of  the  surface  of  the  body 
produces  this  result.  If,  after  twelve  hours,  no  urine 
is  passed  the  child  should  be  placed  in  a  hot  bath  of 
110°  F.,  when  the  urine  will  usually  be  passed.  An- 
other method  of  inducing  the  flow  of  urine  is  to 
apply  cloths,  wTung  out  in  hot  water,  to  the  abdomen 
and  to  the  genital  organs.  An  enema  made  up  of  a 
pint  of  salt-water  at  a  temperature  of  110°  F.  w^ill 
probably  be  effective  if  the  other  measures  fail.  As 
a  last  resort  a  catheter  should  be  passed  by  a  physician 
to  relieve  the  bladder  distension,  and  internal  medi- 
cation given. 


BED-WETTING.     INCONTINENCE  OF  URINE 

The  involuntary  passage  of  urine  up  to  the  third 
year  of  age  should  not  be  considered  an  abnormality, 
though  many  children,  if  properly  trained,  can  be 
taught  to  make  their  wants  known  and  voluntarily 
void  their  urine  when  two  years,  or  even  one  year  and 
a  half,  old. 

If  a  child  continues  to  wet  the  bed  after  the  third 
year  medical  advice  should  be  sought. 

Incontinence  of  urine  may  be  due  to  any  one  of  a 
variety  of  causes,  such  as  adenoids,  constipation, 
worms,  tight  or  adherent  foreskin,  highly  acid  urine. 
With  girls,  inflammation  of  the  vulva,  or  vagina,  may 
be  responsible  for  this  condition.  Occasionally  an 
abnormally  small  bladder  or  stone  in  the  bladder 
brings  about  this  difficulty.     In  the  majority  of  cases, 


146  THE  CHILD 

however,  it  is  of  nervous  origin,  the  proper  nerve 
control  of  the  bladder  not  being  sufficiently  devel- 
oped. Bed- wetting  may  sometimes  be  due  to  the  fact 
that  the  child  drinks  a  large  quantity  of  liquids  at 
night,  ^here  this  is  the  case  the  mother  may  do 
much  to  control  the  difficulty  by  giving  a  simple,  dry 
supper  consisting  of  a  cereal,  with  butter  and  sugar, 
bread  and  butter,  and  stewed  prunes.  Nothing  should 
be  given  to  drink  after  4  p.m.,  and  at  10  or  11  p.m. 
the  child  should  be  taken  up  and  placed  upon  the 
chamber  and  made  to  pass  its  urine. 

If  adenoids,  worms,  or  other  abnormal  conditions 
are  present,  appropriate  treatment  should  be  employed 
as  indicated  elsewhere.  If  this  does  not  alleviate  the 
trouble,  proper  medication,  together  with  the  faithful 
co-operation  of  the  mother,  will  usually  bring  relief, 
although  some  little  time  will  probably  be  required 
to  establish  a  permanent  cure. 


CHILDREN'S  PARTIES 

It  is  a  common  custom  to  give  birthday  and  other 
parties  to  young  children  of  the  runabout  age,  or 
even  younger.  Six  or  eight  little  ones  of  the  same 
age  are  invited,  and  animal  crackers,  cakes,  colored 
ice-cream,  and  pink  lemonade  are  served. 

The  little  host  and  little  guests  have  their  stomachs 
filled  with  nicknacks  to  which  they  are  not  accus- 
tomed,  and   there   results,   very   probably,    an  acute 


THE  CHILD  147 

attack  of  indigestion,  accompanied  by  vomiting  and 
diarrhoea,  and,  frequently,  convulsions. 

Such  a  party,  bringing  together  a  number  of  little 
children,  has  very  often  been  the  means  of  spreading 
contagious  diseases,  which  are  always  more  serious 
at  this  tender  age  than  a  few  years  later. 


EXCITEMENT 

Excitement,  in  the  shape  of  too  much  play  or 
fondling,  or  that  brought  about  by  being  with  noisy 
children  or  adults,  is  an  extremely  bad  thing  for 
infants  and  young  children.^ 

The  nervous  system  of  an  infant  or  young  child 
is  in  a  very  undeveloped  and  unstable  condition,  and 
it  only  takes  a  little  to  overtax  it.  Many  parents  do 
not  know  or  realize  this  fact,  and  the  baby  is  allowed 
to  be  present  at  afternoon  tea-parties,  birthday  parties, 
and  holiday  festivities,  w^here  it  is  seen,  handled, 
kissed,  and  talked  to  by  many  strangers ;  all  of  which 
is  extremely  injurious  to  the  nervous  system,  although 
it  may  make  the  child  scream  with  apparent  pleasure. 
I  have  many  times  been  a  witness  of  the  resulting 
exhaustion  to  the  baby  after  some  such  function. 
Indeed,  hardly  a  day  passes  that  I  do  not  see  this 
over-fondling  and  over-indulging  going  on,  and 
caution  mothers  against  it. 


148  THE  CHILD 

DISORDERS  OF  SLEEP 

Restless  sleep  in  babies  is  usually  due  to  indigestion 
resulting  from  improper  or  over-feeding;  but  it  may 
be  caused  by  hunger,  or,  in  some  cases,  by  pain  or 
itching;  occasionally  it  comes  from  teething,  pain  in 
the  ear,  or  colic.  Not  infrequently  feeding  at  night 
is  a  cause. 

In  older  children  the  commonest  cause  is  indiges- 
tion. Adenoids  or  enlarged  tonsils,  poor  ventilation 
in  the  sleeping-rooms,  cold  feet,  constipation,  too 
much  or  too  little  bedclothing,  anaemia,  whooping- 
cough,  malnutrition,  St.  Vitus'  dance,  exciting  stories 
at  night,  exciting  scenes,  or  violent  play,  may  all 
be  causes  of  restlessness  or  wakefulness  at  night, 
and  careful  investigations  should  be  made  to  find  out 
which  of  these  is  responsible  for  the  difficulty. 


NIGHT  TERRORS 

These  attacks  are  not  infrequent  with  children,  and 
are  due  usually  to  the  same  causes  as  those  mentioned 
under  ^^  Disorders  of  Sleep.''  They  are  like  a  night- 
mare. The  child  awakens  suddenly  with  a  start,  very 
much  terrified,  and  sometimes  in  a  state  of  cold  per- 
spiration. It  says  it  had  a  bad  dream,  it  sees  animals 
or  men,  and  is  too  frightened  to  stay  alone.  Some- 
times the  child  will  wake  up  in  a  dazed  condition  and 
will  not  recognize  the  mother  or  nurse. 

Night  terrors  are  very  apt  to  follow  a  Thanksgiving 


THE  CHILD  149 

dinner  or  children 's  party,  where  all  sorts  of  unaccus- 
tomed things  have  been  eaten. 

Often  a  child  can  be  quieted  by  having  a  light  in 
the  room  or  being  taken  into  the  mother's  or  nurse's 
bed.  No  soothing  syrups  of  any  kind  should  ever 
be  given.  If  mothers  could  only  realize  the  danger 
from  these  nostrums,  which  contain  opium,  they  would 
never  allow  them  in  the  house.  All  disorders  of  sleep 
are  best  treated  by  removing  the  cause,  and  when  this 
has  been  done  there  will  be  no  difficulty  in  sleeping. 
If  the  diet  is  at  fault,  then  it  should  be  made  very 
simple.  There  may  have  to  be  made  changes  in  the 
modification  of  the  milk.  All  bad  habits,  such  as 
giving  food  at  night,  hearing  exciting  stories,  or  join- 
ing in  exciting  play,  should  be  stopped.  The  child 
should  have  a  light  and  simple  supper,  such  as  a 
cereal  and  milk,  and  should  be  put  to  bed  early  in  a 
well-ventilated  room.  Often  a  warm  bath  just  before 
going  to  bed  will  insure  sleep.  Other  conditions,  such 
as  adenoids,  anaemia,  malnutrition,  etc.,  will  require 
appropriate  treatment. 


CONVULSIONS 

A  convulsion  is  a  brief  nervous  disturbance  char- 
acterized by  an  involuntary  rhythmical  spasm  of  any 
or  all  the  muscles,  and  usually  by  loss  of  consciousness. 
Young  babies  are  particularly  susceptible  to  convul- 
sions during  the  first  year.  At  that  time  the  nervous 
system  is  in  an  extremely  unstable  condition  because 


150  THE  CHILD 

of  the  brain's  rapid  growth,  which  is  greater  during 
the  first  year  than  in  all  the  years  that  follow. 

My  experience  has  taught  me,  after  treating  very 
many  cases  of  convulsions  arising  from  various  causes, 
that  the  vast  number  of  cases  (over  ninety  per  cent) 
result  from  some  disturbance  of  the  digestive  organs. 
All  these  cases  have  occurred  in  bottle  babies  badly 
fed,  or  in  older  children  who  have  been  given  all 
sorts  of  food  unsuited  to  their  years. 

Convulsions  very  frequently  usher  in  the  acute  con- 
tagious diseases — influenza,  scarlet  fever,  measles,  and 
also  pneumonia.  Convulsions  are  seen  in  epilepsy. 
Severe  attacks  of  convulsions  may  cause  hemorrhage 
into  the  brain  with  resulting  paralysis. 


FINGER  AND  THUMB  SUCKING 

Infants,  especially  during  the  early  months,  very 
often  form  the  habit  of  sucking  the  hand,  thumb, 
fingers,  toes,  arm,  or,  perhaps,  some  foreign  object, 
such  as  a  ''  sugar  teat  ''  or  rubber  nipple.  This  habit 
may  be  accompanied  by  the  rubbing  of  some  part,  such 
as  the  head  or  the  genital  organs,  by  pulling  the  hair  or 
ear,  or  scratching  the  head  or  body.  Habits  of  this 
kind  may  continue  through  infancy  and  childhood  if 
stringent  measures  are  not  taken  to  break  them  in 
very  early  infancy.  The  longer  the  habit  persists  the 
harder  will  it  be  to  overcome,  and  serious  deformity 
to  the  lips,  teeth,  £;nd  even  the  jaw,  have  been  known 
to  result. 


THE  CHILD  151 

These  habits  have  a  great  tendency  to  develop  mas- 
turbation. In  order  to  overcome  any  of  these  habits 
treatment  should  be  begun  early.  Infants  who  prac- 
tise them  should  have  their  hands  pinned  inside  their 
sleeves  by  securely  fastening  the  opening  of  the  sleeves 
at  the  wrist  with  safety  pins,  or  by  means  of  tape 
fastened  around  each  wrist  and  attached  to  a  belt, 
or  pinning  band,  long  enough  to  allow  free  movement 
of  the  arms,  but  preventing  the  hands  from  reaching 
the  mouth  if  thumb  sucking  is  the  habit  to  be  cured. 
Another  method  wiiich  is  admirably  adapted  to  both 
infants  and  older  children  is  to  place  on  their  hands 
the  '*  Hand-I-Hold  ''  babe  mits,  which  are  celluloid 
balls  perforated  with  holes.  There  are  numerous 
other  methods  of  keeping  the  child  ^s  hands  from  its 
mouth,  but  these  I  have  mentioned  are  to  be  preferred. 
Mechanical  methods  of  treatment  are  the  best.  I  have 
had  little  or  no  success  in  bandaging  the  hands  or 
applying  bitter  substances  to  them ;  these  precautions 
do  not  seem  to  deter  children  in  the  least  from  this 
habit.  Older  children  should  not  be  punished  for 
thumb  sucking,  but  rewarded  for  not  doing  it. 


NAIL  BITING 

The  habit  of  nail  biting  is  best  overcome  by  keeping 
the  nails  cut  very  short. 


152  THE  CHILD 

"  THE  PACIFIER '' 

.  The  use  of  this  rubber  nipple,  which  often  plays 
so  large  a  part  in  the  care  of  the  baby,  is  one  of  the 
worst  habits  that  has  come  under  my  observation. 

It  is  a  common  thing  to  see  the  '^  pacifier  "  tied 
about  an  infant's  neck  so  that  it  may  always  be  at 
hand  ready  to  place  in  the  mouth.  I  have  often  seen 
the  ^^  pacifier,"  dropped  upon  the  dirty  floor  or 
street,  picked  up  by  the  nurse  or  mother,  and  placed 
in  the  child's  mouth;  perhaps  first  wiping  it  off  on 
handkerchief  or  dress. 

It  is  not  difficult  to  see  what  a  carrier  of  all  kinds 
of  germs  this  innocent  looking  little  rubber  appliance 
may  be.  Diphtheria,  tonsilitis,  thrush,  tuberculosis, 
and  syphilis  are  some  of  the  most  serious  diseases 
that  may  be  contracted  by  means  of  the  ^^  pacifier.'' 
Besides,  it  is  a  very  bad  habit  in  itself  to  use  a 
^\  pacifier  "  to  quiet  a  baby  every  time  it  cries. 

Constant  sucking  causes  a  chronic  congestion  in 
the  back  of  the  throat  with  resulting  adenoids.  This 
word  of  warning  should  be  sufficient  to  convince  every 
wise  mother  that  her  baby  should  never  become  ac- 
quainted with  the  ^^  pacifier." 


MASTURBATION 

This  is  not  an  uncommon  habit  among  children,  and 
it  may  occur  even  in  young  babies.  It  is  most  detri- 
mental to  the  health  of  a  child.     In  the  case  of  boys 


THE  CHILD  153 

it  is  frequently  the  result  of  some  irritation  of  the 
genital  organ,  such  as  a  long  or  tight  foreskin,  smegma 
under  the  foreskin,  highly  acid  urine,  etc.,  while  in 
the  case  of  girls  it  may  be  from  irritative  discharges, 
highly  acid  urine,  or  some  abnormal  condition  of  the 
genital  organs.  Constipation,  pin  worms,  sleeping  in 
warm  feather-beds,  thumb,  finger,  or  hand  sucking, 
and  tight  or  irritating  clothing  may  bring  about  this 
condition  in  either  sex. 

With  older  children  the  symptoms  are  quite  char- 
acteristic. Children  who  have  contracted  this  habit 
are  pale,  sleep  poorly,  are  easily  tired,  have  dark  rings 
under  the  eyes,  often  complain  of  headaches,  are  very 
quiet,  have  little  animation,  and  do  not  care  to  asso- 
ciate with  other  children.  They  are  apt  to  be  absent- 
minded,  and  are  unable  to  concentrate  their  attention. 

If  this  condition  is  allowed  to  continue  they  become 
morbid,  and,  in  extreme  cases,  may  even  develop 
melancholia  and  mental  weakness,  insanity,  or  epi- 
lepsy. 

Masturbation  in  infants  and  very  young  children 
may  not  be  recognized  by  the  mother  until  it  has 
continued  for  some  time,  and  even  then  the  meaning 
of  the  symptoms  is  rarely  realized  at  this  tender 
age.  Masturbation  is  usually  brought  about  by  rub- 
bing the  genital  organs  against  some  object,  or  by 
crossing  the  thighs  and  causing  friction  by  constantly 
rubbing  them  against  each  other.  In  older  children, 
especially  boys,  the  act  is  frequently  accomplished 
by  means  of  the  hands,  but  numerous  other  ways  may 
be  employed. 


154  THE  CHILD 

During  the  act  of  masturbation  the  child  ^s  face 
becomes  flushed,  there  is  rigidity  of  the  body  and 
lower  extremities,  followed  by  relaxation,  more  or  less 
exhaustion,  and  often  perspiration. 

It  is  very  important  that  this  condition  be  recog- 
nized early  and  that  it  receive  appropriate  treatment, 
as  it  is  much  more  easily  cured  in  its  earliest  stages 
than  after  it  has  been  practised  for  some  time  and 
become  a  fixed  habit.  All  local  causes  such  as  have 
been  mentioned    (if  they  exist)    should  be  removed. 

In  the  case  of  babies,  and  children  under  two  or 
three  years  of  age,  if  they  have  acquired  the  habit 
of  thigh  rubbing,  a  very  thick  diaper  or  pad  may  be 
applied,  so  that  the  thighs  cannot  be  brought  together. 
In  the  case  of  older  children  a  crutch  for  this  purpose 
is  employed.  When  the  hands  are  used  they  should 
be  tied  about  each  wrist  with  a  bandage  which  passes 
back  of  the  neck  and  is  tied  in  front,  and  which  should 
be  long  enough  to  allow  free  use  of  the  arms  and 
yet  short  enough  to  prevent  the  hands  from  reaching 
the  genitals.  Another  method  that  may  be  employed 
in  these  cases  is  to  inclose  the  hands  in  the  '*  Hand-I- 
Hold  ''  celluloid  babe  mits. 

Older  children  should  be  kept  from  bad  companions, 
left  alone  as  little  as  possible,  and  helped  and  en- 
couraged to  strengthen  their  will  power,  and  so  over- 
come this  habit.  They  should  also  be  kept  in  the 
open  air  as  much  as  possible,  given  cold  salt-baths, 
and  in  every  way  efforts  should  be  made  to  improve 
their  general  physical  condition  as  much  as  possible. 


THE  CHILD  155 

STUTTERING,  STAMMERING,  LISPING, 
DELAYED  TALKING 

Stuttering  is  occasionally  seen  in  a  great  many 
children,  especially  when  they  are  learning  to  talk 
but  have  not  completely  mastered  the  art.  At  this 
agfe^ti^t  is  temporary,  lasting  for  a  few  weeks  or  months, 
only.  It  not  infrequently  accompanies  malnutrition 
or  anaemia,  or  follows  some  one  of  the  acute  illnesses. 

Stuttering  may  be  inherited,  or  may  be  acquired 
from  imitation  of,  or  being  constantly  with,  one  who 
stutters.  Permanent  stuttering  does  not  occur  until 
about  the  sixth  year  of  age. 

Practically  all  cases  in  very  young  children  recover 
entirely,  but  they  should  be  carefully  watched  to 
prevent  it  becoming  a  fixed  habit.  Older  children 
should  be  under  the  care  of  a  competent  teacher,  who 
teaches  them  how  to  breathe  and  the  use  of  the  voice, 
tongue,  and  lips  in  speaking. 

Stammering  is  very  similar  to  stuttering,  except 
that  certain  separate  sounds  are  hard  to  make,  usually 
on  account  of  some  defect  of  the  lips,  tongue,  teeth, 
or  palate.  These  defects  should  be  corrected  and  the 
child  be  carefully  trained  in  speech. 

Lisping  is  due  to  some  fault  of  the  organs  of  articu- 
lation and  should  be  treated  in  the  same  way  as 
stammering. 

Backwardness  in  learning  to  talk  may  be  due  to  a 
long  or  serious  illness  in  an  otherwise  normal  child; 
or  it  may  be  due  to  idiocy.  Children  two  years  old 
who  are  not  deaf  should  be  able  to  speak. 


156  THE  CHILD 

VACCINATION 

Babies  in  good  health  should  be  vaccinated  by  the 
fourth  or  fifth  month,  as  the  younger  the  child  the 
less  will  be  the  constitutional  disturbance.  The  place 
chosen  in  vaccinating  girls  is  the  outer  side  of  the 
calf  of  the  leg,  as  at  this  point  there  is  less  danger 
of  injury  to  the  resulting  scab  and  of  leaving  an 
objectionable  scar  than  would  be  the  case  in  vaccinat- 
ing the  arm.  Boys,  however,  may  be  vaccinated  on 
the  left  arm. 

Only  a  small  area,  an  eighth  of  an  inch  square, 
should  be  scarified.  No  vaccination  shield  should  be 
used,  as  by  its  use  the  wound  is  much  more  apt  to 
become  infected.  The  shield  usually  becomes  dis- 
placed and  so  causes  irritation  and  very  probably 
infection. 

After  a  child  has  been  vaccinated  a  sterile  gauze 
dressing  should  be  applied,  which  should  not  be  re- 
moved for  three  or  four  days,  when  a  clean  dressing 
should  be  applied. 

If  the  vaccination  becomes  infected  and  causes 
trouble  it  is  usually  due  to  uncleanliness  in  the  care 
of  the  wound,  not  to  the  vaccine  matter.  On  the 
tenth  day  the  reaction  and  fever  are  at  their  height. 
Tub  bathing  should  be  stopped  until  after  the  scab 
falls  off. 

GRIPPE,  INFLUENZA 

This  is  an  infectious  communicable  disease  and  is 
due  to  a  specific  germ.     It  occurs  sometimes  in  severe 


THE  CHILD  157 

epidemics,  but  ordinarily  appears  every  year,  fre- 
quently during  the  winter  months.  The  period  of 
incubation  is  short,  varying,  in  most  cases,  from  one 
to  seven  days.  When  uncomplicated  this  disease  lasts 
from  two  to  seven  days,  but  complications  are  fre- 
quent, especially  bronchitis,  acute  inflammation  of 
the  glands  of  the  neck,  pneumonia,  otitis  media, 
diarrhoea,  and  digestive  troubles. 

The  onset  is  usually  abrupt ;  the  symptoms  are  chil- 
liness, fever,  muscular  pains,  great  prostration,  head- 
ache, and  sometimes  vomiting  or  convulsions.  The 
temperature  ranges  from  101°  to  103°  P.  in  the  mild 
cases,  but  in  the  severe  form  may  be  102°  to  106°  F. 
Marked  prostration  is  characteristic  of  all  forms  of 
this  disease,  Sometimes  cases  closely  resemble  typhoid 
fever,  with  heavily  coated  dry  tongue,  parched  lips, 
and  rapid,  weak  pulse.  Although  in  the  uncomplicated 
cases  the  severe  symptoms  with  high  fever  usually  last 
only  a  few  days  it  takes  a  long  time  to  recover  from 
the  effects  of  the  disease,  and  the  system  is  always  left 
in  a  weakened  condition. 

Catarrhal  symptoms  often  predominate,  with  severe 
cold  in  the  head,  sore  throat,  and  frequently  ton- 
silitis.  The  infection  often  involves  the  ear,  with  re- 
sulting otitis,  and  the  glands  of  the  neck  may  become 
swollen.  In  the  most  severe  cases  the  bronchial  tubes 
and  lungs  may  become  affected  and  broncho-pneu- 
monia ensue. 

In  other  cases  we  have  vomiting  and  diarrhoea  pre- 
dominating, together  with  other  general  symptoms 
of  fev^r  and  prostration,     Infants  under  six  months 


158  THE  CHILD 

of  age  may  not  be  able  to  resist  the  severity  of  the 
poison  of  influenza,  and  succumb  in  two  or  three  days, 
or,  after  a  week  of  increasing  prostration,  may  die. 
Not  a  few  of  these  severe  cases  develop  pneumonia, 
which  brings  about  a  fatal  termination. 

A  child  with  influenza  should  be  isolated  in  a  room 
by  itself,  and  kept  in  bed  as  long  as  the  fever  lasts. 
At  the  onset  hot  drinks  should  be  administered  and 
the  patient  placed  in  a  hot  pack  to  induce  free  per- 
spiration, and  a  full  dose  of  castor-oil  should  be  given. 
After  the  acute  symptoms  are  over  the  child  will  re- 
quire tonics,  and  maltine  and  cod-liver  oil  for  the 
cough,  which  often  persists.  A  change  of  a  few 
weeks  to  a  warm  dry  climate  will  effect  a  cure  more 
quickly  than  anything  else.  The  mountains.  Hot 
Springs,  Virginia,  North  Carolina,  Lakewood,  or  At- 
lantic City  makes  the  most  beneficial  change  when 
it  is  possible  to  bring  it  about.  Tuberculosis  is  espe- 
cially prone  to  follow  in  the  wake  of  influenza,  and 
should  be  very  carefully  guarded  against. 


DIPHTHERIA 

Diphtheria  is  one  of  the  most  insidious',  treacherous, 
and  dangerous  diseases  to  which  children  are  subject. 
•  It  is  due  to  a  specific  germ  called,  from  its  discoverers, 
the  Klebs-Loefi^ler  bacillus. 

The  period  of  incubation  is  variable.  Children  may 
develop  the  disease  a  few  hours  after  exposure,  or 
it  may  not  appear  for  several  weeks.     A  bacteriolog- 


THE  CHILD  159 

ical  examination  of  the  throat  is  the  only  sure 
means  of  determining  whether  the  disease  will  de- 
velop. 

Diphtheria  may  be  contracted  by  direct  contact, 
or  the  germs  may  be  carried  in  clothing,  books,  toys, 
etc.  One  attack  does  not  confer  immunity  to  the 
patient  for  more  than  a  few  weeks,  and  second  and 
third  attacks  are  frequent.  Diphtheria  usually  at- 
tacks either  the  nose,  throat,  or  larynx,  but  may  affect 
any  mucous  membrane.  The  onset  of  the  disease  is 
usually  gradual,  with  loss  of  appetite,  sore  throat, 
slight  fever,  headache,  indisposition,  and  irritability; 
there  may  be  slight  swelling  of  the  glands  at  the 
angle  of  the  jaw,  and  pain  on  swallowing.  The  ton- 
sils may  be  swollen  and  red,  and  frequently  irregular 
patches  of  a  dirty  white  or  grayish  membrane  on  one 
or  both  of  them  may  be  seen.  This  membrane  may 
be  yellow  in  color,  and  the  appearance  of  the  tonsil 
may  closely  resemble  tonsilitis;  sometimes  the  only 
way  of  distinguishing  between  them  is  by  a  bac- 
teriological examination. 

In  nasal  diphtheria  there  is  frequently  no  visible 
membrane,  but  there  is  always  a  foul,  bloody  discharge 
from  the  nose,  which  may  last  weeks  or  months,  with 
little  or  no  accompanying  fever. 

Laryngeal  diphtheria  is  the  most  serious  and  quickly 
fatal  of  any  form  of  this  disease.  Its  symptoms  are 
like  those  of  croup,  but  it  is  more  insidious  in  its 
onset.  The  symptoms  grow  steadily  worse,  and  pros- 
tration supervenes.  The  child  becomes  blue,  the 
breathing  labored,  and,  if  relief  is  not  immediate, 


160  THE  CHILD 

death  ensues  from  suffocation.  Frequently  this  type 
of  the  disease  requires  intubation. 

Diphtheria  antitoxin  has  been  proved  beyond  doubt 
to  be  a  specific  for  the  disease,  and  is  the  means  of 
saving  thousands  of  lives  every  year.  It  should  be 
given  at  once  as  soon  as  the  diagnosis  is  made.  If 
there  is  the  slightest  doubt  as  to  whether  the  case  is 
one  of  diphtheria  or  tonsilitis  it  is  not  safe  to  wait 
for  a  bacteriological  examination,  as  it  may  be  too 
late. 

The  initial  dose  of  antitoxin  in  most  cases  should' 
be  10,000  units,  and  never  in  any  case  less  than  5,000 
units.  Local  treatment  with  antiseptic  mouth  washes 
and  gargles  in  connection  with  antitoxin  are  valuable, 
but  should  never  be  relied  upon  alone. 

A  child  with  diphtheria  should  be  kept  in  bed  so 
long  as  there  is  fever,  and  under  strict  quarantine 
until  bacteriological  examination  shows  the  nose  and 
throat  to  be  free  from  the  diphtheria  germ.  All  dis- 
charges should  be  disinfected  with  a  1  to  20  solution 
of  carbolic  acid,  and  at  the  termination  of  the  disease 
fumigation  and  disinfection  done  as  in  scarlet  fever. 


SCARLET  FEVER 

Scarlet  fever  should  always  be  regarded  as  a  most 
serious  disease  on  account  of  its  frequent  and  danger- 
ous complications.  Its  period  of  incubation  is  from 
one  to  six  days,  and  it  is  contagious  from  the  appear- 
ance of  the  first  symptom  until  desquamation  is  com- 


THE  CHILD  161 

pleted,  which  may  be  as  long  as  six  weeks.  If  puru- 
lent discharge  is  present  from  the  nose,  ear,  or  other 
mucous  surface  contagion  continues  until  such  dis- 
charge has  been  cured.  The  risk  of  contagion  is 
greatest  during  the  febrile  stage. 

The  onset  of  scarlet  fever  is  sudden,  with  high  fever, 
rapid  pulse,  sore  throat,  prostration,  frequently  vomit- 
ing, and  rarely  convulsions.  The  rash  appears  from 
twelve  to  twenty-four  hours  after  the  initial  symp- 
toms, though  there  are  cases  where  it  does  not  appear 
until  the  third  or  fourth  day.  It  is  usually  seen  first 
upon  the  neck  and  chest,  but  frequently  also  in  the 
groin  and  on  the  thighs  and  back.  It  spreads  very 
rapidly  over  the  whole  body,  in  the  course  of  a  few 
hours  the  face  also  being  involved.  A  peculiar  pallor 
about  the  mouth  is  almost  always  present  in  this 
disease. 

The  rash  is  of  a  bright  scarlet  color,  and  consists 
of  minute  red  points  so  close  together  that,  from  a 
distance,  there  is  the  appearance  of  a  uniform  blush ; 
in  fact,  the  appearance  is  that  of  a  ''  boiled  lobster.'' 
With  the  full  development  of  the  eruption  there  is 
intense  itching  of  the  skin. 

There  are  all  grades  of  severity  in  scarlet  fever, 
from  the  very  mild  cases,  where  the  fever  is  only 
101°  F.  and  the  rash  so  slight  that  it  may  easily  be 
overlooked,  and  lasting  only  a  few  hours,  to  the  most 
severe  and  malignant  forms. 

In  moderately  severe  cases  the  fever  rises  rapidly, 
and  by  the  end  of  twenty-four  hours  has  reached 
104°  F.  or  105°  F.     The  intensity  of  the  rash,  which 


162  THE  CHILD 

appears  during  the  first  twenty-four  hours,  is  in  direct 
proportion  to  the  severity  of  the  other  symptoms. 
The  tongue  is  coated,  and  on  account  of  the  intense 
redness  of  its  tip  and  margin,  and  the  prominence 
of  its  papillae,  is  called  the  ' '  strawberry  tongue  ' '  and 
is  a  marked  characteristic  of  the  disease. 

The  throat  is  red,  and  the  tonsils  look  inflamed 
and  may  even  have  membranous  looking  exudates 
upon  them.  The  patient  is  very  restless  and  has  great 
thirst.  The  glands  at  the  angles  of  the  jaw  may  be 
enlarged  and  tender,  causing  pain  on  swallowing.  At 
the  second  or  third  day  the  fever  is  at  its  height,  and 
as  a  rule,  about  the  fourth  or  fifth  day  it  begins  to 
fall  gradually  with  the  fading  of  the  rash ;  but  in 
some  cases,  even  if  there  are  no  complications,  the 
fever  may  last  for  ten  or  twelve  days. 

The  heart  action  is  always  rapid  in  the  beginning 
of  the  disease ;  later  it  may  be  weak.  There  is  always 
more  or  less  prostration. 

The  complications  most  common  in  scarlet  fever 
are  otitis  media,  or  abscess  in  the  ear,  acute  Bright 's 
disease  of  the  kidneys,  inflammation,  swelling,  and 
sometimes  abscess,  of  the  glands  of  the  neck,  and 
cellulitis  of  the  neck. 

Scarlatinal  synovitis  of  the  joints,  and,  more  rarely, 
membranous  sore  throat  or  diphtheritic  sore  throat, 
pleuro-pneumonia,  or  heart  disease  (endocarditis) 
may  complicate  scarlet  fever. 

Scarlet  fever  is  due  to  a  germ  that  gains  entrance 
into  the  body  through  the  nose  or  throat,  and,  in  some 
instances,    probably  through    an   open    wound.     The 


THE  CHILD  163 

contagion  is  very  tenacious,  and  may  be  transmitted 
from  one  person  to  another  by  direct  contact,  or  by 
means  of  infected  clothing,  books,  toys,  milk,  etc.  The 
contagion,  under  favorable  conditions,  may  remain 
active  for  months,  and  produce  the  disease  as  oppor- 
tunity presents  itself. 

"When  a  child  contracts  scarlet  fever  it  should  be 
isolated  at  once  in  a  room  that  can  be  most  easily 
quarantined,  if  possible  on  the  top  floor.  Children 
in  the  house,  who  have  not  been  exposed,  should  be 
quarantined  in  another  room  for  a  week  to  see  if  they 
come  down  with  the  disease. 

After  the  child  has  recovered,  before  being  allowed 
to  mingle  with  other  children,,  the  hair  should  be  cut 
short  and  the  child  should  have  a  thorough  scrub 
bath  from  head  to  foot  with  soap  and  warm  water, 
followed  by  an  antiseptic  bath  of  1  to  5,000  bichloride 
of  mercury  solution. 

The  nurse  should  be  under  a  strict  quarantine  as 
well  as  the  patient,  and  never  go  into  another  room 
or  mingle  with  the  family  until  she  has  changed  her 
clothes  and  washed  and  disinfected  her  hands  and 
face.  She  should  always  wear  a  close-fitting  cap  while 
on  duty,  to  avoid  infection  of  the  hair  and  scalp. 

The  physician  who  is  in  charge  of  a  case  of  scarlet 
fever  before  entering  the  sick-room  should  remove 
his  coat  and  overcoat,  and  put  on  a  long  gown  that 
buttons  tightly  about  the  neck  and  extends  to  the 
ankles.  On  leaving  the  sick-room  he  should  wash  and 
disinfect  his  hands  and  face. 

When  desquamation  begins  the  child  should  receive 


164  THE  CHILD 

a  daily  warm  antiseptic  bath,  followed  by  a  rub  with 
white  vaseline  or  boracic  acid  ointment.  This  will 
hasten  the  removal  of  the  scales  and  prevent  the 
spread  of  the  disease.  During  the  height  of  the  rash 
and  fever  warm  baths,  followed  by  vaseline  inunctions, 
are  soothing  and  restful,  and  help  to  reduce  the  tem- 
perature and  allay  the  intense  itching.  An  antiseptic 
gargle  should  be  used  several  times  a  day  to  cleanse 
the  mouth  and  throat.  A  child  with  scarlet  fever 
should  not  be  allowed  out  of  bed,  and  should  be  kept 
on  a  liquid  diet  for  three  weeks.  All  discharges  from 
the  patient  should  be  at  once  disinfected,  also  all  cloth- 
ing or  bed  linen  before  being  sent  to  the  wash. 

On  the  termination  of  the  case,  after  fumigation 
of  the  room  and  steam  sterilization  of  its  bedding, 
carpets,  etc.,  the  walls  should  be  repapered  or  painted, 
the  floor  scrubbed  and  then  washed  with  an  anti- 
septic, and  the  woodwork  painted,  when  this  is 
possible. 

MEASLES 

Measles  is  one  of  the  most  contagious  diseases.  One 
attack  usually  protects  against  a  second,  but  not  in- 
variably. I  have  myself  seen  a  few  undoubted  second 
attacks. 

The  period  of  incubation  is  from  thirteen  to  fifteen 
days,  counting  from  the  time  of  exposure  to  the  ap- 
pearance of  the  rash,  or  for  from  nine  to  ten  days 
from  the  appearance  of  the  first  symptom. 

Measles  begins  very  much  like  a  cold  in  the  head, 


THE  CHILD  165 

with  a  dry  cough,  sneezing,  and  running  from  the 
nose.  The  eyes  become  red  and  the  lids  swollen, 
the  light  gives  pain  and  causes  watering  of  the  eyes. 
There  is  loss  of  appetite,  and  slight  fever  of  100°  to 
102°  F.  At  this  time  the  mucous  membrane  of  the 
throat  and  mouth  becomes  red.  On  the  third  or 
fourth  day  the  characteristic  rash  breaks  out,  first 
on  the  temples  and  face,  and  then  rapidly  spreads 
to  the  body  and  extremities.  This  rash  appears  as 
small  rose-red  spots  which  quickly  develop  into 
papules  that  may  coalesce,  giving  the  face  a  very 
much  swollen  and  congested  appearance. 

The  papules  of  measles  have  a  distinctly  crescentic 
arrangement.  It  takes  two  days  for  the  rash  to 
develop  fully.  It  remains  at  its  height  for  two  or 
three  days,  then  begins  to  fade,  and  in  two  or  three 
days  is  entirely  gone.  When  the  rash  is  at  its  height 
the  fever  is  highest,  ranging  from  103°  to  105°  F., 
but  subsides  with  the  subsidence  of  the  rash,  when 
desquamation,  or  shedding  of  the  skin  in  fine  scales, 
begins.  This  usually  takes  from  ten  days  to  two 
weeks,  but  may  be  hastened  by  warm  baths,  followed 
by  inunctions  with  white  vaseline.  The  period  of 
quarantine  in  New  York  is  at  least  three  weeks. 

Measles  is  contracted  by  direct  contact,  and  is  not 
transmitted  by  a  third  person  or  by  means  of  clothes, 
books,  etc.  It  is  probably  most  contagious  during  the 
early  or  catarrhal  stage  of  the  disease. 

A  child  with  measles  should  be  isolated  in  a  room 
by  itself,  put  on  a  reduced  diet,  consisting  mostly  of 
broth,  soup,  and  milk  for  older  children,  and  diluted 


166  THE  CHILD 

milk  for  babies.  A  warm  bath  should  be  given  every 
day,  followed  by  inunctions  of  white  vaseline.  The 
patient  should  remain  in  bed  so  long  as  there  is  any 
fever.  The  sick-room  should  be  darkened,  and  the 
eyes  washed  several  times  a  day  with  a  saturated 
solution  of  boracic  acid. 

Measles  is  considered  by  many  not  to  be  serious  in 
its  nature.  In  young  and  delicate  children,  however, 
measles  not  only  in  itself  may  be  dangerous,  but  on 
account  of  the  complications,  especially  bronchitis  and 
pneumonia,  which  not  infrequently  arise,  may  be 
fatal. 

To  avoid  such  complications  cases  of  measles  should 
be  under  the  supervision  of  a  physician  whenever  this 
is  possible. 

GERMAN  MEASLES 

German  measles  is  usually  a  very  mild  disease,  and 
is  much  less  contagious  than  either  measles  or  scarlet 
fever. 

The  period  of  incubation  is  variable,  but  in  a  major- 
ity of  cases  is  from  eight  to  sixteen  days.  There  may 
be  symptoms  of  a  mild  catarrh,  with  indisposition, 
drowsiness,  and  slight  fever,  before  the  rash  appears ; 
but  usually  there  is  an  eruption  upon  the  face  of  small 
pale  red  or  pinkish  papules  from  the  size  of  a  pin's 
head  to  that  of  a  pea.  These  papules  rapidly  spread 
to  the  rest  of  the  body  and  may  last  only  a  few  hours, 
or  one  or  two  days,  or,  at  the  longest,  three  days. 
They  fade  rapidly,  and  the  slight  desquamation  fol- 
lowing may  last  from  one  to  four  or  five  days. 


THE  CHILD  167 

There  is  a  slight  swelling  of  the  glands  at  the  back 
of  the  neck  and  angle  of  the  jaw  in  German  measles, 
which  is  most  marked  at  the  height  of  the  disease 
and  subsides  slowly  without  suppuration. 

One  attack  usually  protects  against  another,  but 
not  against  measles.     Quarantine  is  not  necessary. 

The  treatment  consists  in  giving  a  cathartic,  warm 
baths,  inunctions  of  white  vaseline,  and  suitable  med- 
ication for  conditions  that  may  arise. 


CHICKEN-POX 

This  is  usually  a  mild  disease  with  no  complica- 
tions. In  rare  instances,  however,  there  may  be  a 
profuse  rash,  with  considerable  temperature.  I  have 
seen  one  or  two  cases  where  the  kidneys  were  in- 
volved, and  a  number  of  cases  where  bad  scars  re- 
sulted resembling  those  of  smallpox. 

The  period  of  incubation  varies  from  two  to  three 
weeks,  but  in  most  instances  the  disease  develops  in 
seventeen  days. 

Usually  the  first  symptom  that  is  noticed  is  the 
appearance  of  the  rash,  which  looks  like  little  water- 
blisters  with  small  red  areas  about  them.  These  come 
out  in  crops,  a  few  at  a  time,  on  the  head  and  face, 
and  then  upon  the  body,  and  can  be  seen  in  all  stages 
of  development  on  different  parts  of  the  body.  The 
fever  is  low,  rarely  going  above  102°  F.,  and  more 
often  not  above  100°  to  101°  F.  There  may  be  slight 
indisposition  and  loss  of  appetite,  but  often,  with  the 


168  THE  CHILD 

exception  of  the  rash,  the  child  seems  apparently  well. 

Children  with  chicken-pox  should  be  kept  in  the 
house  for  a  few  days  until  the  rash  begins  to  dry  and 
form  scabs,  but  they  need  not  be  under  strict  quaran- 
tine unless  there  is  danger  of  exposure  to  other  chil- 
dren who  are  young  and  delicate. 

Children  with  chicken-pox  should  not  be  allowed 
to  go  to  school  or  be  with  other  children  until  the 
skin  is  perfectly  clear,  which  usually  takes  about  three 
weeks. 

It  is  important  that  there  should  be  no  scratching, 
as  scars  may  result.  The  itching  can  be  greatly  re- 
lieved by  sponging  with  alcohol  or  soda  and  water, 
and  then  anointing  freely  with  boracic  acid  ointment. 


MUMPS 

Mumps  is  an  inflammation  involving  the  parotid 
gland.  This  gland  is  situated  in  the  front,  below 
and  behind  the  ear,  where  the  swelling  appears.  The 
submaxillary  gland  at  the  angle  of  the  jaw^  is  also 
frequently  involved,  and  any  of  the  salivary  glands 
may  be;  rarely  the  testicle  or  ovary.  It  is  probably 
only  contagious  from  direct  contact.  One  attack  pro- 
tects against  a  second. 

The  period  of  incubation  varies,  but  in  the  majority 
of  cases  is  from  two  to  three  weeks. 

The  first  symptoms  are  usually  headache,  drowsi- 
ness, loss  of  appetite,  with  slight  fever  and  reddened 
throat.     Then  the  parotid,  usually  first  on  one  side, 


THE  CHILD  169 

becomes  swollen,  there  is  pain  on  chewing  and  swal- 
lowing at  the  angle  of  the  jaw,  and  acids  or  sour 
things  cause  pain  when  taken  into  the  mouth.  The 
fever  ranges  from  100°  F.  to  103°  F.  Usually  the 
glands  on  both  sides  of  the  face  are  affected,  but  not 
at  precisely  the  same  time,  one  side  preceding  the 
other  by  a  couple  of  days. 

The  swelling  of  the  glands  continues  for  three  or 
fotir  days,  when  it  begins  to  subside,  and  at  the  end 
of  four  or  five  days  has  reached  its  normal  size. 

There  are  rarely  any  complications  of  a  serious 
nature  accompanying  mumps,  and  it  cannot  be  con- 
sidered a  serious  disease  when  proper  precautions  are 
taken. 

A  child  with  mumps  should  be  put  to  bed  in  a  room 
by  itself,  and  kept  on  fluid  diet  until  the  fever  and 
swelling  have  subsided.  An  antiseptic  mouth  wash 
and  gargle  should  be  used  several  times  a  day,  hot 
applications  of  towels  wrung  out  in  hot  water  should 
be  renewed  every  half-hour  or  so  over  the  swelling, 
and  applications  of  warm  ichthyol,  or  guaiacol,  should 
also  be  kept  up.  At  the  beginning  of  an  attack  the 
bowels  should  be  thoroughly  opened  by  means  of  a 
saline  cathartic. 


WHOOPING-COUGH,  OR  PERTUSSIS 

Whooping-cough  in  later  childhood  may  be  ranked 
among  the  milder  contagious  diseases,  but  in  infants 
and  delicate  children  it  is  a  most  serious  and  often 


170  THE  CHILD 

fatal  disease.  This  is  because  of  the  frequent  com- 
plications that  ensue,  the  principal  ones  being  broncho- 
pneumonia, convulsions,  and,  in  summer,  diarrhoea. 

It  is  estimated  that  at  least  two- thirds  of  the  deaths 
from  whooping-cough  occur  during  the  first  year  of 
life,  and  of  this  number  the  largest  proportion  are 
from  broncho-pneumonia,  the  next  from  diarrhoea, 
and  the  last  come  convulsions. 

Whooping-cough  is  due  to  a  germ,  and  may  be  com- 
municated to  others  from  the  beginning  of  the 
catarrhal,  or  first,  stage  of  the  disease  until  after  the 
spasmodic  stage  is  passed,  and  possibly  longer. 

The  period  of  incubation  is  usually  about  two 
weeks,  but  may  be  shorter.  In  w^hooping-cough  there 
are  usually  three  stages  in  the  progress  of  the  disease : 
these  are  known  as  the  catarrhal,  the  spasmodic,  and 
the  stage  of  decline.  The  catarrhal  stage  usually  lasts 
from  one  to  two  weeks.  The  symptoms  are  fir.it,  a 
cough — such  as  is  seen  in  bronchitis — which,  at  the 
end  of  a  week,  becomes  more  serious,  with  recurrent 
paroxysms.  These  paroxysms  increase  in  frequency 
until  the  typical  crowing  sound,  known  as  the  whoop, 
and  indicating  that  the  spasmodic  stage  has  begun, 
is  heard.  From  now  on  the  typical  paroxysms  will 
occur  more  and  more  frequently,  after  each  series  of 
explosive  coughs  there  will  be  the  characteristic  whoop 
and  expulsion  of  a  plug  of  mucus  from  the  throat, 
while  during  the  paroxysm  the  eyes  protrude  and 
the  face  is  of  a  deep  red,  and,  sometimes,  even  of  a 
purple  hue.  Vomiting  occurs  with  most  of  the  severe 
paroxysms  of  coughing  especially  if  they  come  shortly 


THE  CHILD  171 

after  eating.  Sometimes  these  are  accompanied  with 
slight  nosebleed.  The  number  of  paroxysms  may 
vary  from  five  or  six,  in  the  beginning,  to  forty  or 
fifty  in  severe  cases,  during  the  twenty-four  hours. 
These  attacks  are  not  only  very  exhausting,  but  on 
account  of  the  frequent  vomiting  of  food,  the  child 
is  enfeebled  from  lack  of  nourishment.  The  parox- 
ysms of  coughing  are  always  more  frequent  and  more 
severe  at  night  and  also  in  a  close  room. 

In  mild  cases  no  whoop  may  be  heard  during  the 
whole  attack,  but  there  is  usually  vomiting,  and  the 
cough  is  of  a  paroxysmal  nature. 

The  whooping  stage  of  the  disease  is  of  a  variable 
duration,  but  in  many  cases  lasts  about  a  month, 
gradually  increasing  in  severity  for  the  first  half, 
and  then  subsiding,  except  when  modified  by  treat- 
ment. 

After  the  whoop  has  ceased  we  have  the  stage  of 
decline,  with  a  cough  resembling  that  of  bronchitis, 
and  this  stage  is  again  variable,  not  infrequently  last- 
ing a  month  or  two  if  neglected. 

My  experience  has  been,  after  treating  923  cases 
of  whooping-cough,  that  a  great  deal  can  be  done  to 
alleviate  the  symptoms,  to  decrease  the  number  and 
severity  of  the  paroxysms,  and  also  the  vomiting,  and 
to  shorten  the  attack  of  the  disease  very  materially. 

The  earlier  cases  come  under  the  care  of  the  physi- 
cian and  proper  medication,  the  less  will  be  the  danger 
of  complications  and  the  more  favorable  will  be  the 
ultimate  result.  Abundance  of  fresh  air  is  of  great 
importance  in  treating  this  disease. 


172  THE  CHILD 

TUBERCULOSIS 

Tuberculosis  is  an  infectious  disease  due  to  the 
tubercle-bacillus.  It  may  attack  almost  any  organ 
of  the  body. 

When  the  lungs  are  affected  it  is  called  pulmonary 
tuberculosis,  or  consumption.  If  the  covering  of  the 
brain  is  affected  it  is  called  tubercular  meningitis; 
if  the  hip-joint,  hip-joint  disease;  if  the  glands  of 
the  neck,  tubercular  adenitis;  if  the  bones  of  the 
spine,  Pott's  disease;  if  the  peritoneum,  we  name  it 
tubercular  peritonitis.  The  kidneys,  bladder,  liver, 
intestines,  and  other  parts  of  the  body  may  be  affected, 
but  the  most  frequent  seat  of  the  disease  is  as  above 
mentioned.  Sometimes,  in  young  babies,  we  find  a 
general  tuberculosis,  or  miliary  tuberculosis. 

The  prognosis  of  tuberculosis  depends  upon  its 
location.  Tubercular  meningitis  and  miliary  tuber- 
culosis are  almost  always  fatal.  Tuberculosis  of  the 
lungs  in  young  infants  is  usually  so,  but  children 
seven  to  ten  years  of  age,  with  proper  management, 
usually  recover.  The  prognosis  of  tuberculosis  of 
the  glands  of  the  neck,  tuberculosis  of  the  hip-joint, 
knee,  or  spine  is  favorable  as  far  as  life  is  concerned. 

Tuberculosis  is  not  hereditary,  but  children  may 
inherit  a  tendency,  or  susceptibility,  to  the  disease. 

The  germ  of  tuberculosis  gains  entrance  into  the 
body  through  the  inspired  air.  It  is  in  the  dust  of 
the  street,  in  public  conveyances,  and  in  the  dust  from 
the  rooms  where  tubercular  people  have  lived.  Tuber- 
culosis may  also  be  transmitted  by  food,  drink,  and 


THE  CHILD  173 

kissing,  and  it  is  dangerous  to  be  near  a  tubercular 
patient  who  is  coughing. 

Cases  of  tuberculosis  must  be  under  the  constant 
care  of  a  physician.  Each  affected  part  of  the  body 
will  require  its  own  special  treatment,  but  all  cases 
need  good  food,  abundance  of  fresh  air,  rest,  and  care- 
ful nursing,  and  they  will  be  more  likely  to  improve 
in  a  dry  climate  at  an  elevation  of  one  thousand  to 
fifteen  hundred  feet  above  the  sea  level. 

The  preventive  treatment  of  tuberculosis  in  chil- 
dren is  to  keep  them  away  from  people  who  have 
the  disease,  and  to  see  that  their  physical  condition 
and  general  health  are  of  the  best.  This  is  to  be  ac- 
complished by  carefully  regulated  diet,  outdoor  exer- 
cise, good  ventilation  at  night,  care  about  catching 
cold,  etc.  These  methods  make  the  child  resistant  to 
the  germs  of  tuberculosis. 

Every  one  at  some  time  has  probably  taken  the 
germs  of  tuberculosis  into  the  body,  but  it  is  only 
in  those  who  are  feeble  and  non-resistant — in  other 
words,  where  the  soil  is  favorable  to  their  growth — 
that  the  germs  gain  not  only  lodgment  but  a  perma- 
nent foothold,  and  tuberculosis  is  the  result.  If  the 
germ  of  tuberculosis  always  caused  the  disease  every 
one  in  the  world  would  probably  die  of  this  trouble. 


RHEUMATISM 

Rheumatism  in   a  child  should   always  be   looked 
upon  as  a  disease  of  serious  nature,  from  the  fact  that, 


174  THE  CHILD 

if  not  taken  in  time,  the  heart  is  so  frequently  affected, 
leaving  the  little  patient,  in  many  cases,  an  invalid 
for  life. 

Eheumatism  is  quite  a  frequent  disease  after  the 
third  year,  and  has  many  symptoms  and  phases  differ- 
ent from  the  rheumatism  in  adults.  It  may  appear 
in  varying  degrees  of  severity.  Not  infrequently  the 
mild  attacks  are  so  slight  that  they  are  overlooked, 
a  physician  is  not  called  in,  and  a  diagnosis  of 
rheumatism  is  not  made.  The  slight  pains  complained 
of  are  considered  ''  growing  pains  "  or  sprains,  and 
only  later,  when  valvular  heart  disease  appears,  it  is 
realized  that  the  child  has  had  rheumatism. 

No  attack  of  rheumatism  is  too  mild  to  be  ignored, 
for  the  mild  cases  are  as  apt  to  have  heart  complica- 
tions as  the  more  severe. 

The  severe  articular  form  of  the  disease  called 
inflammatory  rheumatism  manifests  itself  by  high 
fever  and  reddened,  swollen,  painful  joints,  the  child 
shrieking  with  pain  if  the  joints  are  touched,  and 
dreading  the  approach  of  any  one  to  the  bedside. 
This  phase,  however,  is  extremely  rare  in  children 
under  eight  or  ten  years  of  age. 

In  every  case  of  rheumatism,  no  matter  how  mild, 
the  heart  should  be  early  and  frequently  examined, 
so  that  the  case  may  have  prompt  and  proper  treat- 
ment. Probably  more  than  eighty  per  cent  of  the 
cases  of  valvular  heart  disease  in  adults  are  due  to 
attacks  of  rheumatism  during  childhood. 

The  onset  is  usually  gradual,  with  slight  fever 
ranging  from  100°  F.  to  101°  F,    There  may  be  slight 


THE  CHILD  175 

swelling  and  pain  in  one  of  the  joints,  those  most 
frequently  affected  being  the  ankle,  knee,  foot,  wrist, 
elbow,  or  hip,  and  there  may  be  more  or  less  stiffness. 
If  the  lower  extremities  are  attacked  the  child  will 
walk  with  a  limp. 

Often  pain  is  complained  of  only  in  the  tendons, 
ligaments,  or  muscles,  one  or  more  ^  of  these  being 
involved.  The  pain  is  generally  more  pronounced 
after  exposure  and  during  damp  weather. 

Other  manifestations  of  .  rheumatism  are  severe 
anaemia,  stiff  neck,  Saint  Vitus'  dance,  tonsilitis,  and 
certain  skin  eruptions. 

On  account  of  its  frequent  recurrence,  with  the 
ever  present  danger  of  cardiac  complications,  children 
who  have  once  had  rheumatism  should  have  interval 
treatment.  That  is,  they  should  see  the  physician 
at  certain  stated  intervals,  and  take  the  anti-rheu- 
matic remedies  a  certain  length  of  time  out  of  every 
month,  whether  symptoms  of  rheumatism  are  present 
or  not.  This  will  keep  the  rheumatic  poison  from 
attacking  the  system. 


SAINT  VITUS'  DANCE,  OR  CHOREA 

Chorea  is  a  nervous  disease  of  rheumatic  origin 
characterized  by  irregular,  uncontrollable,  spasmodic 
movements  of  the  voluntary  muscles  of  the  body,  and 
great  mental  irritability.  It  occurs  most  frequently 
between  the  ages  of  six  and  fourteen  years,  and  girls 
are  more  often  affected  than  boys. 


176  THE  CHILD 

Chorea  is  gradual  in  its  onset,  and  is  not  accom- 
panied by  fever.  Usually  the  first  symptom  noticed 
is  that  the  child  appears  nervous,  irritable,  is  easily 
frightened,  and  cries  or  laughs  without  cause.  The 
child  may  be  reprimanded  for  not  sitting  still,  for 
wriggling,  making  grimaces  in  school,  or  for  picking 
its  clothing,  drumming  with  its  fingers,  dropping 
things  from  the  hands,  when  really  it  deserves  no 
reprimand,  as  the  disease  destroys  all  nerve  control. 
When  the  legs  are  affected  the  gait  is  uncertain,  there 
will  be  difficulty  in  climbing  stairs,  and  frequent  stum- 
bling or  falling.  In  some  cases  spasmodic  twitchings 
first  begin  in  the  muscles  of  the  face,  so  that  the 
child  appears  to  be  making  faces. 

The  spasmodic  movements  become  steadily  worse 
until  a  large  number  of  the  muscles  of  the  body  are 
involved.  The  movements  are  irregular  and  jerky, 
varying  in  intensity  from  occasional  muscular  twitch- 
ings to  nearly  continuous  motion.  The  child  has  no 
control  over  these  movements,  and  they  are  aggra- 
vated by  any  attempt  to  stop  them  either  on  the  part 
of  the  patient  or  others.  Excitement  or  fatigue  in- 
creases these  movements,  but  they  are  not  present 
when  the  child  is  asleep.  Speech  is  not  infrequently 
affected,  because  of  involvement  of  the  muscles  of  the 
tongue  and  lips  and  other  muscles  that  take  part  in 
the  act  of  speech.  The  child  will  attempt  to  speak 
and  will  pronounce  several  syllables  correctly;  then 
suddenly  the  voice  will  drop  to  a  whisper  or  not  be 
heard  at  all.  Meanwhile,  the  child  is  making  attempts 
to  pronounce  several  words,  and  indulging  in  all  kind§ 


THE  CHILD  177 

of  droll  and  fantastic  gestures  which  make  it  appear 
ridiculous.  After  a  little  it  will,  perhaps,  be  able  to 
utter  a  few  more  words,  and  then  the  same  difficulty 
will  be  experienced,  with  the  result  that  the  child 
becomes  hysterical,  breaks  down,  and  cries. 

These  are  the  symptoms  in  the  moderately  severe 
cases,  but  there  are  all  grades  of  severity,  from  the 
very  mild  attacks  to  those  extremely  severe,  when  the 
choreic  movements  are  so  intense  and  constant  that 
the  child  cannot  stand  or  sit  alone,  cannot  articulate, 
or  cannot  be  kept  still  in  bed,  but  throws  itself  aim- 
lessly about  and,  if  not  mechanically  restrained,  will 
inflict  severe  bruises  or  other  injuries  upon  itself. 
In  this  form  of  the  disease  the  patient  is  very  wake- 
ful, and  loss  of  sleep  is  found  very  wearing.  Children 
so  affected  have  poor  appetites  and  are  often  pale 
and  anaemic  looking. 

Mild  cases  or  those  of  moderate  severity  may  be 
otherwise  in  fairly  good  health,  but  frequently  have 
headaches,  poor  appetites,  sleep  badly,  and  are  easily 
fatigued. 

One  of  the  greatest  dangers  from  chorea  is  com- 
plication by  an  acute  endocarditis  (heart  disease). 
On  this  account,  and  from  the  fact  that  relapses  and 
second  attacks  or  other  rheumatic  affections  are  com- 
mon, every  case  of  chorea  should  be  under  the  constant 
care  of  a  physician,  and  the  heart  frequently  exam- 
ined. 

A  child  with  an  attack  of  Saint  Vitus'  dance  should 
have  absolute  rest,  and  all  excitement  should  be 
avoided.     Until  the  pronounced  choreic  movements 


178  THE  CHILD 

subside  the  little  patient  should  be  kept  in  bed  and 
never  punished  or  ridiculed  on  account  of  the  choreic 
movements. 

The  diet  should  be  simple  and  nutritious,  all  stim- 
ulants, such  as  tea  and  coffee,  being  forbidden. 

Fresh  air  is  important,  but  only  a  slight  amount 
of  exercise  should  be  allowed  and  its  effect  on  the 
child  carefully  watched.  Warm  baths  given  daily, 
combined  with  a  moderate  amount  of  gentle  massage, 
are  of  decided  value  in  some  cases,  while  in  others 
cold  sponging  may  be  of  more  benefit.  All  cases 
require  iron  tonics,  maltine,  and  cod-liver  oil,  besides 
the  specific  medicines  which  are  given  in  this  dis- 
ease. 

An  attack  of  chorea  usually  lasts  about  six  weeks, 
but  may  be  prolonged  to  three  months,  and  in  a  few 
severe  cases  drags  on  for  a  year.  It  should  be  re- 
membered that  this  disease  is  very  apt  to  recur,  and 
children  who  have  had  it  should  be  carefully  watched 
for  any  symptoms  of  its  reappearance;  they  should 
have  long  vacations  and  should  never  be  pressed  in 
their  studies,  and  they  should  be  under  the  care  of 
a  physician,  and  seen  by  him  at  regular  inter- 
vals. 

In  chorea  much  can  be  done  to  alleviate  the  symp- 
toms, shorten  the  attack,  and  prevent  such  a  com- 
plication as  endocarditis  by  faithful  co-operation  on 
the  part  of  the  mother  with  the  physician  in  charge. 


THE  CHILD  179 

MALARIA 

This  is  a  disease  which,  in  its  milder  form,  is  fre- 
quently mistaken  for  other  diseases,  and,  consequently, 
does  not  receive  correct  treatment. 

Malaria  is  caused  by  a  specific  micro-organism  in 
the  blood  called  the  Plasmodium  malariae. 

The  symptoms  of  the  milder  form  are  drowsiness, 
loss  of  appetite,  slight  fever,  or,  perhaps,  peevishness 
or  f retf ulness ;  after  a  time  the  patient  looks  pale  and 
thin,  and  continues  to  lose  weight.  These  symptoms 
may  last  for  several  weeks  before  more  characteristic 
and  definite  ones  appear. 

The  more  characteristic  cases  have  the  symptoms 
of  fever  and  drowsiness  at  a  certain  hour  each  day, 
or  every  other  day,  while  between  these  periods  the 
child  is  apparently  well. 

Other  cases  manifest  themselves  by  a  chill,  with 
chattering  of  the  teeth  or  chilly  sensations,  accom- 
panied by  high  fever  and  followed  by  a  profuse 
perspiration  and  subsidence  of  the  fever.  These 
symptoms  usually  occur  every  second  or  third  day. 

The  cure  for  malaria  is  quinine,  which  should  always 
be  given  under  the  direction  of  a  physician  who  has 
made  a  blood  examination  and  found  the  micro-organ- 
ism present. 

QUARANTINE  ROOM  FOR  CONTAGIOUS  DISEASES 

This  room  should,  if  possible,  be  completely  isolated. 
In  a  house,  it  should  be  on  the  top  floor.     If  in  an 


180  THE  CHILD 

apartment,  it  should  be  the  room  least  used  and  the 
one  that  can  be  shut  off  from  the  other  rooms. 

.  The  child  ill  with  a  contagious  disease  should  be 
placed  in  this  room  with  the  mother  or  nurse,  and 
neither  allowed  to  come  out  nor  see  the  other  members 
of  the  family.  The  furniture  should  be  as  simple  as 
possible,  the  floor  bare,  and  there  should  be  no  fancy 
curtains  or  hangings  on  the  wall.  The  clothing  worn 
by  the  attendant  should  be  of  washable  material,  so 
that  when  changed  it  can  be  placed  with  the  bed  linen 
in  boiling  water  which  has  had  a  tablespoonful  of 
carbolic  acid  to  two  gallons  of  water  added.  This 
should  be  done  before  it  is  given  to  the  laundry.  The 
meals  should  be  left  outside  the  sick-room  door,  and 
the  nurse  should  get  them  from  there,  and  before 
returning  the  dishes  should  place  them  in  boiling 
water  for  five  or  ten  minutes  in  order  to  sterilize  them. 


DISINFECTION    FOR    CONTAGIOUS     DISEASES- 
FUMIGATION 

After  a  case  of  contagious  disease  the  child  should 
be  given  a  warm  tub  bath,  using  a  soft  brush  and 
plenty  of  soap.  The  head  should  be  washed  with  a 
1  to  2,000  solution  of  bichloride  of  mercury,  and  after 
this  is  done  the  child  should  be  removed  from  the 
sick-room  and  dressed  in  clean  clothing.  The  bed 
linen  and  soiled  clothing  should  be  put  to  soak  in  a 
1  to  500  solution  of  carbolic  acid,  which  is  two  tea- 


THE  CHILD 


181 


spoonfuls  to  the  gallon  of  water,  and  left  until  they 
are  washed.  Before  washing  they  should  be  boiled 
for  thirty  minutes. 

Before  the  fumigation  all  cracks  or  crevices  in  the 
room  must  be  sealed  to  prevent  the  disinfectant  from 
escaping.  Four  pounds  of  sulphur  are  required  for 
every  1,000  cubic  feet  of  air  space.     The  sulphur 


Scbering's  Formalin  Fumigator. 


should  be  placed  in  an  iron  kettle,  which  is  set  on 
two  or  three  bricks  in  a  tub  containing  a  couple  of 
inches  of  water  to  prevent  fire.  Alcohol  is  then  poured 
over  the  sulphur,  it  is  lighted,  and  the  room  kept 
closed  for  eight  hours. 

A  more  convenient  and  perhaps  more  thorough 
means  of  disinfection  is  the  use  of  formalin,  six 
ounces  for  every  1,000  cubic  feet  of  air  space  and 
four  hours'  exposure. 


182  THE  CHILD 

For  this  purpose  ^  Schering  's  Formalin  Disinf  ector 
is  very  convenient  and  inexpensive.  Formalin  Dis- 
infection is  preferable  where  possible. 

In   all   large   cities,   after  the   mattresses,    pillows, 

carpet,  or  rugs  have  been  fumigated,  they  are  taken 

charge  of  by  the  department  of  health, 

are  subjected  to  steam  under  pressure, 

and    returned   free    of   charge.     Where 

this    cannot    be    done    the    pillows    and 

mattresses   should   be   well   aired   after 

fumigation  and  recovered.     The  floor  of 

the  room  and  the  woodwork  should  be 

scrubbed  with  hot  w^ater  and  soap,  and 

when  dry  should  be  washed  again  with 

Formalin  Lamp  ^  ^  ^^  ^fi^^  bichloride  of  mercury  solu- 

(Sclieririg).     tion.      The    furniture    should    also    be 

washed  with  the  bichloride  solution,  and 

also  the  walls  and  ceilings,  unless  they  are  repapered 

or  painted. 

The  formalin  lamp  "*  is  a  simple,  convenient,  and 
safe  little  appliance  for  disinfection  and  deodorization 
of  the  sick-room  or  closets  containing  clothing,  etc. 
It  is  only  available  for  rooms  less  than  800  cubic  feet 
in  space. 

*Schering's  Formalin  Disinf  ector  is  furnished  at  a  cost  of  four 
dollars  ($4.00),  and  the  formalin  lamp  for  $1  50,  and  are  an  excel- 
lent help  in  fumigation.  These  are  both  sold  by  Schering  & 
Glatz,  150  Maiden  Lane,  New  York  City. 


THE  CHILD  183 

FLIES  AND  MOSQUITOES 

Comparatively  few  persons  realize  the  great  source 
of  danger  that  flies  and  mosquitoes  m-ay  become,  and 
how  important  it  is  to  screen  them  from  the  house 
and  prevent  their  coming  near  the  baby  when  it  is 
out  of  doors ;  this  can  be  done  by  means  of  mosquito 
netting.  Flies  are  very  filthy  insects ;  they  feed  upon 
all  kinds  of  refuse  and  filth,  and  become  contaminated 
with  all  manner  of  micro-organisms,  which  they  carry 
about  with  them  and  with  which  they  infect  whatever 
they  light  upon.  In  this  way  many  of  our  worst 
diseases,  such  as  tuberculosis,  typhoid  fever,  diph- 
theria, and  many  others,  are  spread. 

The  little  fly  is  especially  attracted  by  the  baby's 
sweetened  milk  or  the  sugar  on  the  child's  cereal, 
and  no  one  knows  but  that  fly  has  just  come  from  the 
excrement  from  a  case  of  typhoid  or  the  sputum 
from  a  case  of  tuberculosis,  and  will  certainly  infect 
the  baby's  food. 

Some  children  are  badly  poisoned  by  the  bites  of 
mosquitoes.  This  is  bad  enough,  but  a  certain  variety 
of  mosquito  carries  the  micro-organism  which  pro- 
duces malaria,  which  is  more  serious,  because  when 
children  are  bitten  by  this  mosquito  they  become  in- 
fected and  malaria  results.  Another  variety  of  this 
wretched  insect  carries  the  yellow  fever  germ,  and 
the  disease  is  in  this  way  transmitted  from  one  person 
to  another. 

All  this  shows  the  great  importance  of  extreme  care 


184  THE  CHILD 

in   protecting  the   child  from  the   dangers  resulting 
from  insect  contamination. 

When  flies  or  mosquitoes  have  gained  entrance  into 
a  house  the  greatest  effort  should  be  made  to  kill 
them. 


WHEN  SHOULD  THE  DOCTOR  BE  SENT  FOR? 

Whenever  symptoms  appear  that  the  mother  does 
not  understand  the  doctor  should  be  called.  Two  con- 
ditions demand  his  services  at  once,  these  are  diar- 
rhoea and  sore  throat;  an  apparently  mild  attack 
of  diarrhoea,  if  it  does  not  have  the  proper  treatment 
immediately,  may  become  serious  or  even  fatal  in  a 
day  or  two.  I  have  seen  cases  of  cholera  infantum 
where  the  patient  died-  in  thirty-six  to  forty-eight 
hours  after  the  onset  of  the  disease. 

Any  sore  throat  or  croupy  cough  may  be  of  diph- 
theritic origin,  and  no  mother  is  competent  to  judge 
of  the  nature  of  the  trouble,  nor  can  she  foretell  what 
the  outcome  of  the  case  may  be.  I  have  known  cases 
of  diphtheritic  croup  to  be  past  hope  in  a  few  hours 
which  could  have  been  conquered  if  treated  by  a  physi- 
cian earlier. 

If  parents  would  only  relieve  themselves  at  once 
of  the  responsibility  of  illness,  many  a  heartache  might 
be  avoided  and  many  a  little  child  kept  from  an 
untimely  death. 

If  people  fully  realized  that  diseases,  though  appar- 
ently slight  or  trivial,  if  allowed  to  progress  without 


THE  CHILD  185 

scientific  treatment,  often  lead  to  grave  conditions  and 
even  to  fatal  termination,  there  would  not  be  so  much 
neglect  of  slight  ailments,  as  we  often  unfortunately 
find. 

A  physician,  if  called  promptly  to  a  case,  can  often 
prevent  a  long  or  a  serious  illness,  or  guard  from  com- 
plications, and  thus  not  only  obviate  much  suffering 
on  the  part  of  the  child,  but  also  avoid  much  worry 
and  large  expense  for  the  parents. 


MEDICINES 

It  cannot  be  too  emphatically  stated  that'the  giving 
of  patent  medicines,  cough  syrups,  soothing  syrups, 
and  patent  diarrhoea  mixtures,  teas,  and  so-called 
blood  medicines  or  tonics  by  a  mother  or  nurse  to  a 
young  child,  on  her  own  responsibility,  is  most  repre- 
hensible and  dangerous.  Most  of  these  preparations 
contain  opium  or  alcohol  in  some  form,  drugs  which 
are  badly  borne  by  infants  and  young  children,  and 
should  never  be  given  except  under  the  directions  of 
one  skilled  in  their  use.  Many  infants  suffer  each 
year  from  the  effects  of  these  nostrums  given  by  well- 
meaning  but  ignorant  mothers. 

A  mother  should  have  a  list  of  simple  remedies 
given  her  by  the  physician,  and  their  uses  explained, 
that  she  may  use  them  in  an  emergency  until  the 
physician  arrives,  but  outside  of  this  she  is  not  ex- 
pected to  know  the  use  of  drugs  or  prescribe  for 
ailments. 


186  THE  CHILD 

WHAT  TO  DO  IN  CASES  OF  ACCIDE^NTAL 
POISONING 

Accidents  will  happen,  and  children  may  get  hold 
of  medicine  bottles  and  drink  part  of  the  contents, 
or  be  given  the  wrong  medicine  by  mistake,  or  suck 
off  the  paint  from  toys. 

The  first  thing  to  do  in  a  case  of  suspected  poison- 
ing is  to  induce  vomiting  as  quickly  as  possible,  to 
rid  the  stomach  of  the  offending  material.  For  this 
purpose  the  throat  may  be  tickled  by  sticking  the 
finger  down  past  the  palate,  and  copious  drinks  of 
lukewarm  water,  or  mustard  and  warm  water,  may 
be  given,  using  a  teaspoonful  of  mustard  to  a  glass 
of  warm  water ;  warm  salt-water,  or  soapy  water,  are 
also  efficacious. 

If  the  poison  taken  is  an  acid,  the  soapy  water  is 
an  antidote  and  will  neutralize  its  effects.  After  the 
stomach  has  been  thoroughly  cleared  out  by  repeated 
vomiting,  soothing  substances  should  be  given,  such 
as  barley-water,  milk,  sweet-oil,  and  the  white  of 
an  egg  that  has  been  thoroughly  beaten. 

Where  there  are  symptoms  of  great  depression,  stim- 
ulants will  be  required  at  once.  Strong  hot  tea,  which 
acts  as  an  antidote  to  many  poisons,  should  be  given 
by  mouth,  hot  water-bottles  should  be  placed  about 
the  body,  and  hot  coffee,  with  brandy  or  whisky  in 
it,  should  be  given  as  an  injection  by  the  rectum 
(bowel),  and  the  patient  kept  flat  on  its  back  in  bed. 

When  a  great  tendency  to  sleep  prevails  it  usually 
indicates  that  one  of  the  various  forms  of  opium  has 


THE  CHILD 


187 


been  taken.  In  such  eases  the  eliild  must  be  kept 
awake  by  dashing  hot  and  eold  water  in  succession 
on  the  head  and  chest,  for  if  allowed  to  sleep  it  may 
never  wake  (as  this  drug  makes  the  patient  forget 
to  breathe).  Care  should  be  taken  that  physical  ex- 
haustion is  not  produced  by  too  strenuous  measures 
used  to  keep  the  patient  awake. 

The  treatment  and  antidote  differ,  of  course,  accord- 
ing to  the  poison  taken.  When  the  poison  is  known, 
if  the  antidote  should  not  happen  to  be  in  the  house, 
vomiting  must  be  at  once  induced  by  large  draughts 
of  warm  water,  or  mustard  water,  and  such  other 
treatment  as  has  been  indicated  above. 


POISONS  AND  THEIR  ANTIDOTES 


POISONS 

For    carboHe    acid    and 
otbeL'  mineral  acids 


For  corrosive  subHmate, 
bedbug  poison,  sugar 
of  lead,  lead-water, 
bhie  vitriol,  saltpeter, 
sulphate  of  zinc 


ANTIDOTES 

Give  chalk,  magnesia  (plaster  off 
the  wall  in  an  emergency),  car- 
bonate of  soda  in  solution, 
flour  and  water,  or  other 
glutinous  or  emollient  drinks, 
large  quantities  of  olive  oil. 

Give  albumen,  white  of  eggs, 
flour,  milk,  and  lime  water 
equal  parts,  use  warm  water, 
mustard  water,  etc.,  to  produce 
vomiting  as  quickly  as  pos- 
sible. If  available  the  stomach 
tube  should  be  used  to  wash 
out  the  stomach. 


188 


THE  CHILD 


For  arsenic,  Fowler's 
Solution,  white  pre- 
cipitate 


Give  mustard  and  salt-water  to 
produce  vomiting;  this  should 
be  followed  by  large  quanti- 
ties of  olive  oil,  milk,  or  butter. 
The  antidote  is  freshly  precip- 
itated hydrated  sesquioxide  of 
iron  made  by  adding  magnesia 
to  any  iron  solution. 


For  strychnine,  nux 
vomica,  rat  and  beetle 
poison 


Give  emetics  of  mustard  water 
and  warm  water,  5  to  10  grains 
of  chloral,  or  10  to.  20  grains 
of  bromide  of  potash  will  be 
required.  The  stomach  should 
be  washed  out  as  soon  as  pos- 
sible. 

The  amount  of  chloral  and  bro- 
mide mentioned  may  be  given 
to  a  child  of  five  or  six  years 
by  rectum  (the  bowel). 


For  chloroform 


Give  fresh  air,  artificial  respira- 
tion, lower  the  head  and  pull 
the  tongue  forward,  pour  cold 
water  over  the  head  and  face, 
hypodermic  stimulation. 


For  aconite 


Give  emetics  of  warm  water,  mus- 
tard water,  stimulants,  such  as 
brandy  and  whisky,  injec- 
tions of  hot  coffee  by  the  rec- 
tum, hot  water-bottles,  keep 
flat  on  the  back. 


THE  CHILD 


189 


For  opium,  laudanum, 
moi*phiiie,  paregoric, 
"  soothing  syrups  " 


If  conscious,  give  emetics  of 
warm  mustard-water  or  greasy 
water  to  produce  vomiting,  or 
use  the  stomach-pump,  keep 
the  child  awake,  use  stimulants 
both  external  and  internal, 
hold  aromatic  spirits  of  am- 
monia to  the  nostrils,  give  hot 
coffee  and  brandy,  use  arti- 
ficial respiration. 


For  caustic  soda  or  cans-      Drink  freely  of  water  with  lemon 
tic  potash,  lye  juice  or  vinegar  in  it,  diluted 

acetic    acid,    olive    oil,    plain 
vinegar,  demulcents. 


For  silver  nitrate 


Give   emetics,   solution   of  com- 
mon salt,  demulcent  drinks. 


For  iodine 


Give  emetics,  demulcent  drinks, 
external  heat,  starch  or  flour 
in  water. 


For  lobelia 


For     phosphorus, 
matches 


Stimulants  externally  and  in- 
ternally, and  external  heat. 

Give  emetics  and  purgatives; 
never  give  oils.  Copper  sul- 
phate in  emetic  dose  is  the 
chemical  antidote. 


For  tobacco 


Give  emetic,  external  and  inter- 
nal stimulants,  and  external 
heat, 


190 


THE  CHILD 


For  stronger  ammonia 
water,  bicarbonate  of 
potassium,  oil  of 
\dtriol,  oxalic  acid, 
hydrochloric  acid 


Give  lime  in  water,  magnesia  or 
soap  dissolved  in  water,  freely, 
in  large  quantities. 


For  wine  of  antimony, 
tartar  emetic 


Give  large  quantities  of  warm 
water  to  encourage  vomiting. 
If  vomiting  does  not  stop  give 
one  grain  of  opium  in  water. 
Give  vegetable  acids,  such  as 
tannic  acid. 


For  copperas,  carbonate 
of  sodium,  cobalt 


Give    emetics,    soapy    water    or 
mucilaginous  drinks. 


For  lead  salts,  as  found 
in  paints 


Give  prompt  emetics,  Epsom  or 
Rochelle  salts,  then  milk  and  a 
grain  of  opium. 


For  belladonna,  atropine 


Give  emetics,  mustard  flour  in 
water,  cold  to  the  head,  stom- 
ach-pump. 


For  disritalis 


Give  emetics,  follow  by  recum- 
bent posture,  tincture  of 
aconite. 


For  illuminating  gas 


Give  fresh  air,  artificial  respira- 
tion, heart  stimulants,  brandy, 
whisky,  and  nitro-glycerin 
given  by  hypodermic. 


For  chlorine  water 


Give  white  of  eggs,  flour^  niilk. 


THE  CHILD 


191 


For     cantharides 
Spanish  fly) 


For  croton  oil 


For  zinc  salts 


(the  Give  emetics,  demulcent  drinks, 
opiates  by  mouth  and  rectum, 
large  draughts  of  water. 

Give  emetics,  wash  out  stomach, 
followed  by  mucilaginous  fluid, 
/containing  opium. 

Give  carbonate  of  soda,  emetics, 
demulcent  drinks. 


For  sausage,  meat,  fish, 
mussels,  cheese 


Give  emetics,  purgatives  (calo- 
mel), stimulants,  emulsions, 
baths.  Foods  should  be  given 
very  cautiously. 


WHERE  TO  SPEND  THE  SUMMER 

Where  to  take  the  child  for  the  summer  months  is 
for  many  an  important  question  to  decide.  Most 
people  think  they  must  either  go  to  the  seashore  or 
to  the  mountains. 

Children  with  catarrhal  or  bronchial  affections,  or 
those  who  have  or  have  had  adenoids,  and  children 
who  are  subject  to  rheumatism,  are  always  better 
when  taken  to  the  mountains  or  to  a  fairly  high  alti- 
tude inland,  where  the  air  is  dry  and  there  is  not 
that  chill  and  dampness  that  is  present  at  night  at 
the  seashore.  The  elevation  need  not  be  more  than 
600  to  1,000  feet  above  the  sea-level  to  give  satisfac- 
tory results. 


192  THE  CHILD 

I  advise  that  all  children  who  live  in  New  York 
City  or  other  seaport  towns  be  taken  inland  to  the 
hills  for  the  summer,  when  this  is  possible,  in  order 
to  give  them  a  complete  change  of  air. 

Pale  delicate  children  are  wonderfully  improved 
in  health  by  a  summer  in  the  countrj^,  and  living  in 
the  open  air. 

If  possible,  children  should  be  kept  out  of  the  city 
from  the  first  of  June  to  the  first  of  October. 

The  more  robust  type  of  child,  and  some  delicate 
children,  may  do  well  and  come  home  benefited  by  a 
sojourn  at  the  seashore.  When  a  place  is  decided 
upon  it  should  be  seen  that  a  good  milk  supply  can  be 
depended  upon,  that  the  water  is  pure,  the  drainage 
perfect,  the  table  generous,  and  the  sleeping-room 
above  the  ground  floor. 

A  small  cottage  has  many  obvious  advantages  over 
a  hotel,  one  being  that  food  can  be  more  easily  pre- 
pared for  the  baby  in  the  kitchen  than  in  a  room  at 
a  hotel. 


LIST  OF  THINGS  TO  TAKE  WHEN  GOING  AWAY 
FOR  THE  SUMMER 

It  will  be  found  very  convenient  when  going  to 
the  country  to  have  the  following  articles  at  hand. 
They  may  all  be  neatly  packed  together  in  a  basket 
or  a  satchel  suitable  for  the  purpose.  It  is  much 
better  to  have  these,  so  far  as  possible,  together,  rather 
than  scattered  through  trunbs. 


THE  CHILD 


193 


Fountain  syringe 

Hot-water  bag 

Roll  of  absorbent  cotton 

Mustard  plasters- 

Court-plasters 

Collodion  or  "  New  Skin  " 

Surgeon's  adhesive  plaster 

Medicine  glass,  graduated 

Glass  funnel 

Clinical  thermometer 

Spoon 

Minim  measuring-glass 

Medicine  dropper 

Knife 

Tweezers 

Pencil 

Labels  for  bottles 

8-ounce  bottle  of  brandy 

8-ounce  bottle  of  whisky 


8-ounce  bottle  of  boracic 
acid  solution 

8-ounce  bottle   of   olive   oil 

4-ounce  bottle  of  castor  oil 

8-ounce  bottle  of  rhubarb 
and  soda  mixture 

2-ounce  bottle  of  syrup  of 
ipecac 

2-ounce  bottle  of  white  vase- 
line 

4-ounce   jar   of  cold   cream 

8-ounce  box  of  bicarbonate 
of  soda 

Scissors 

Corkscrew 

Gauze 

Bandages 

Rubber  tub 


WHAT  EVERY  CHILD  SHOULD  KNOW 

At  the  age  of  nine  or  ten  years  the  mother  or 
father  should  take  the  child  into  his  or  her  confidence 
and  explain  to  it  in  simple  language  the  difference 
between  the  sexes,  and  the  functions  of  the  generative 
organs.  This  explanation  will  prevent  the  erroneous 
ideas  about  these  important  matters  which  may  be 
gained  from  bad  associates,  and  will  give  our  boys 
and  girls  such  knowledge  as  will  enable  them  to  pro- 
tect themselves  against  venereal  disease. 

Dr.  Edith  B.  Lowery  has  written  an  excellent  book- 


194  THE  CHILD 

let  entitled  * '  Confidence-Talks  with  a  Young  Girl 
Concerning  Herself,"  published  by  Forbes  &  Co.,  of 
Chicago.  This  little  book  tells  the  young  girl  in  a 
beautiful  way  what  she  ought  to  know,  and  every 
mother  should  read  it  to  her  daughter. 

Very  good  talks  along  this  line  have  been  got  out 
in  small  educational  pamphlet  series  by  the  Society 
of  Sanitary  and  Moral  Prophylaxis,  33  West  Forty- 
second  Street,  New  York,  both  for  boys  and  girls. 
''  Talks  with  My  Uncle,  the  Doctor,''  is  a  little  book 
of  special  value  for  the  instruction  of  boys. 


MENTAL  INFLUENCE  OVER  THE  YOUNG 
RECEPTIVE  MIND 

The  mental  influence  that  can  be  exerted  over  the 
receptive  mind  for  good  or  evil  is  very  great.  Parents 
can  do  much  toward  influencing  a  child  in  the  right 
way  by  studying  its  mental  processes,  learning  its 
likes,  dislikes,  and  susceptibilities.  They  themselves 
should  be  such  examples  in  conversation  and  action 
as  they  would  wish  their  child  to  follow.  They 
should  influence  the  child  by  suggestion,  and  work 
upon  its  pride.  It  should  be  remembered  that  imi- 
tation is  a  large  factor  in  the  education  of  children. 

It  is  only  too  true  that  the  child  is  image  of  the 
man,  and  reflects  the  character  of  its  parents  by  its 
actions.  It  is  therefore  of  primary  importance  that 
our  boys  and  girls  have  wise  and  careful  training  while 
young  if  we  wish  them  to  be  loving,  obedient,  as  well 


THE  CHILD  195 

as  healthy  children,  and  finally  grow  up  to  be  good 
citizens. 

Children  should  be  reasoned  with,  things  explained 
to  them,  so  that  they  may  comprehend  clearly  why 
one  action  is  wrong  and  another  right.  Much  more 
can  be  accomplished  in  this  way  than  by  punishment. 
To  win  the  confidence  of  a  child  and  never  allow  that 
confidence  to  be  shaken  is  of  the  greatest  importance 
to  its  proper  upbringing. 

All  these  factors,  influencing  the  child  for  good 
or  ill,  indirectly  affect  the  health,  and  so  appear  to 
come  within  the  province  of  the  physician.  A  badly 
trained  child  is  never  as  responsive  to  therapeutic 
measures  as  the  well-disciplined  and  obedient  patient. 


PROBLEMS  OF  THE  VILLAGE,  SUBURBAN,  AND 
COUNTRY  MOTHER;  AND  WAYS  TO  MEET 
THEM 

The  care  and  bringing  up  of  children  in  the  country 
or  small  village  is  attended  with  many  problems  quite 
different  from  those  met  by  the  city  mother. 

There  is  the  lack  of  running  water  and  bathroom 
conveniences.  This  is  one  reason  why  many  prospec- 
tive mothers  prefer  to  go  to  a  hospital  for  their  con- 
finement. 

In  rural  districts  there  is  also  the  difficulty  of 
getting  milk  which  is  iced  soon  after  milking.  It  is 
sometimes  almost  impossible  for  the  country  milkman 
to  ice  his  milk  before  delivering  it.     With  this  in 


196  THE  CHILD 

view  it  would  be  well  for  the  mother  to  depend  upon 
the  nearest  milk  supply  or  the  milkman  who  delivers 
most  promptly,  and  see  herself  that  the  milk  is  put 
upon  ice  as  soon  as  received.  If  the  parents  possess 
a  cow,  of  course  the  problem  is  simplified,  and  a 
raw,  fresh  milk  properly  iced  and  ready  for  modi- 
fication can  be  depended  upon. 

The  advantage  of  obtaining  milk  from  a  mixed 
herd  is  that  the  composition  is  more  uniform.  A 
child  may  be  made  ill  from  drinking  the  milk  from 
a  single  cow,  if  that  cow  is  temporarily  sick  or  out  of 
sorts.  There  is  less  danger  of  such  disturbance  when 
the  milk  is  taken  from  several  cows. 

Where  incomes  permit,  the  Walker-Gordon  Com- 
pany will  express  iced  milk  anywhere  east  of  St.  Louis 
or  north  of  Atlanta,  Georgia,  though  at  considerable 
expense.  It  is  much  better  to  secure  properly  iced 
milk  at  whatever  trouble  or  expense  than  to  depend 
upon  any  of  the  prepared  foods,  milk  powders,  or 
condensed  milk.  No  one  food  is  so  valuable  for  very 
young  children  as  pure  cow's  milk. 

The  quality  of  the  milk  may  be  responsible,  espe- 
cially during  the  hot  weather,  for  many  baby  ill- 
nesses. If  dairy  conditions  are  not  sanitary,  if  the 
cows  are  not  properly  fed  with  fresh  food,  if  every- 
thing connected  with  the  milking  is  not  cleanly,  then 
the  milk  is  sure  to  be  contaminated. 

Dairies  supplying  milk  for  large  cities  in  the  East- 
ern and  Northern  States  are  fortunately  regulated  by 
well-enforced  laws  covering  these  objections,  but  in 
the  Southern  and  far  Western   States,   where   such 


THE  CHILD  197 

efficiency  has  not  been  reached,  the  dairy  conditions 
are,  in  many  instances,  questionable  and  the  milk 
supply  often  not  of  the  best.  People  depending  on 
such  a  milk  supply  had  best  sterilize  the  milk  that 
is  used  for  the  baby  immediately  upon  delivery ;  cer- 
tainly during  the  summer  months.  The  milk  supply 
should  be  carefully  investigated,  and  all  conditions 
surrounding  the  producing  and  marketing  of  the 
milk  looked  into;  if  these  are  not  satisfactory,  and 
the  milk  is  not  cooled  immediately  to  a  temperature 
of  45°  F.  and  put  in  sealed  bottles,  another  milkman 
more  nearly  approaching  the  ideal  should  be  patron- 
ized. 

The  dressing  of  children  who  live  in  the  country 
is  of  importance  and  presents  different  features  from 
the  requirements  of  the  city  child.  It  is  necessary 
to  consider  more  carefully  the  changes  in  the  weather, 
the  dampness  and  chill  from  the  ground,  the  walks 
over  wet  roads  during  the  thawing  springtime,  and 
the  chilly  evenings  and  nights.  In  view  of  all  this 
it  is  very  necessary  to  take  off  and  put  on  flannels 
as  the  weather  changes.  A  good  suggestion  is  to  have 
two  white  and  two  gray  or  striped  flannel  under- 
dresses,  plainly  made,  to  button  up  in  the  back.  The 
white  flannel  dresses  to  be  worn  with  a  white  slip 
in  the  afternoon,  and  the  colored  dress,  under  a 
colored  apron,  in  the  morning.  Eiderdown  booties 
for  a  child  eight  or  ten  months  old  are  essential. 
They  should  be  made  by  the  half-dozen  and  put  on 
over  stockings.  This  will  insure  warm  feet  if  the 
child  is  in  the  walker  or  near  the  floor,  even  if  the 


198  THE  CHILD 

floor  itself  should  be  cold.     These  booties  can  be  easily 
washed,  and  can  be  made  either  in  white  or  in  colors. 

Children  of  the  runabout  age  should  be  well  pro- 
tected from  dampness  when  out  of  doors.  They  should 
wear  good  storm  rubbers,  and  in  the  winter  and  early 
spring  long  leggings,  sweaters,  and  greatcoats.  It  is 
unwise  to  allow  children  out-of-doors  after  the  dew 
has  fallen. 

A  bright  active  child  is  very  apt  to  overplay,  with- 
out a  realization  on  the  part  of  the  parents  that  it  is 
overdoing;  on  this  account,  the  need  of  enforced  rest 
or  sleep  in  the  middle  of  the  day  should  be  insisted 
upon.  This  will  prevent  any  tendency  to  nervous- 
ness and  give  the  body  a  chance  to  grow  and  develop 
in  a  normal  way. 

One  problem  that  the  country  mother  has  to  face 
is  the  difficulty  of  obtaining  help,  either  to  care  for 
the  children,  or  do  housework.  The  many  interests 
of  the  house,  garden,  fruit  canning,  chickens,  etc., 
are  very  apt  to  interfere  with  the  care  of  the  children, 
make  the  mother  neglect  them,  or  break  down  her 
own  health.  It  is,  of  course,  a  very  difficult  situation, 
but  the  mother  should  remember  that  the  interests 
of  her  children  are  the  most  important  and  that  what- 
ever is  neglected  her  duty  to  them  is  paramount. 


DANGERS  IN  THE  COUNTRY 

There  are  certain  dangers  peculiar  to  country  life 
for  which  the  careful  mother  should  always  be  on  the 


THE  CHILD  199 

lookout.  The  children  may  eat  unripe  fruit,  they 
may  become  poisoned,  either  externally  or  internally, 
from  shrubs  or  berries,  and  there  is  the  possibility 
of  poisoning  by  mushrooms  or  toadstools. 

The  roofs,  haystacks,  and  trees  are  a  menace  to 
life  and  limb  should  the  child  fall  from  any  of  them. 

Country  children  delight  to  ''  go  barefoot  ''  during 
the  summer,  and  stone-bruise,  cuts  from  broken  glass, 
injury  by  stepping  on  rusty  nails  may  be  the  result. 
In  the  case  of  injury  by  a  rusty  nail  there  is  always 
the  possibility  that  lockjaw  may  develop. 

Children  should  be  taught  to  avoid  all  sharp  tools, 
such  as  scythes,  pitchforks,  axes,  etc. 

Children  are  always  so  interested  in  animals  that 
on  a  farm  they  may  run  the  risk  of  being  kicked  or 
bitten  by  a  vicious  horse,  or  injured  by  angry  fowls. 
I  have  a  friend  who  lost  an  eye  from  the  attack  of  a 
game-cock.  Another  friend  had  his  ear  nearly  torn 
off  by  the  bite  of  a  horse,  and  I  have  known  many 
cases  where  arms  have  been  badly  bitten  by  horses; 
all  of  w^hich  proves  the  necessity  of  teaching  even 
very  young  children  great  caution  with  regard  to  the 
domestic  animals. 

When  a  child  has  eaten  unripe  fruit,  and  is  suffer- 
ing from  severe  pain  due  to  colic  it  should  be  given 
copious  draughts  of  tepid  salt-water,  or  mustard  water, 
in  order  to  induce  vomiting  and  so  rid  the  stomach 
of  the  offending  material.  The  bowels  should  be  thor- 
oughly cleansed  by  means  of  an  irrigation  of  warm 
salt-water  given  with  a  fountain  syringe.  A  hot 
water-bag  should  be  applied  to  the  stomach,  a  tea- 


200  '  THE  CHILD 

spoonful  of  paregoric  given,  the  child  put  to  bed, 
and,  if  relief  is  not  immediate,  the  doctor  should  be 
sent  for. 

When  poisonous  fungi,  such  as  mushrooms,  etc., 
have  been  eaten,  vomiting  should  be  induced,  as  above 
stated,  and  a  stimulant,  either  brandy  or  whisky, 
given.  The  child  should  be  kept  flat  on  its  back  in 
bed,  and  a  cathartic,  such  as  calomel  or  citrate  of 
magnesia  water,  given. 

The  treatment  for  bruises,  sprains,  and  cuts  has 
been  described  under  their  respective  headings,  but 
it  is  well  to  remember  that  equal  parts  of  powdered 
rosin  and  sugar  bound  on  a  cut  is  one  of  the  best  home 
remedies  to  stop  the  bleeding  and  close  up  the  wound, 
while  lead  and  opium  wash,  applied  as  a  wet  dressing 
over  a  bruise  or  sprain,  will  reduce  the  inflammation 
and  relieve  the  pain,  so  that  both  these  preparations 
should  be  kept  in  readiness. 

For  stone-bruise  one  of  the  best  household  remedies 
is  to  bind  a  piece  of  salt  pork  over  the  sole  of  the 
heel  where  the  stone-bruise  appears.  This  softens  the 
thick  skin  so  that  the  bruise  can  be  opened  and  the 
pus  evacuated. 

If  a  child  steps  on  a  rusty  nail  the  foot  and  wound 
should  be  carefully  washed  with  warm  water  and 
soap.  The  wound  should  then  be  thoroughly  cleansed 
with  hydrogen  peroxide,  then  with  alcohol,  and  finally 
painted  with  several  coats  of  tincture  of  iodine.  This 
done,  the  wound  should  be  tied  up  in  a  wet  dressing 
of  gauze  soaked  in  boracic  acid  solution.  There*  is 
a  tetanus  antitoxin  now  made  which  can  be  admin- 


THE  CHILD  201 

istered  by  the  doctor  in  case  there  should  be  symptoms 
of  lockjaw. 

The  following  list  of  some  of  nature 's  remedies  has 
been  found  valuable  by  many  country  mothers : 

Plantain  leaves  soaked  in  hot  vinegar  and  water 
will  reduce  inflammation  by  binding  the  hot  leaves 
over  the  inflamed  surface  and  repeating  when  the 
leaves  are  dry. 

Wild-cherry  bounce,  made  at  home,  w  ith  the  cherries 
steeped  in  /brandy  and  sugar,  will  act  most  benefi- 
cially on  the  bowels  in  case  of  diarrhoea. 

Ragweed  is  nature's  antidote  for  poison-ivy,  rubbed 
on  where  the  ivy  has  touched  the  skin. 

Young  dandelion  and  turnip  tops  boiled  as  spinach 
are  nature's  spring  tonic;  also  young  sassafras  roots 
can  be  boiled  and  the  water  used  as  a  palatable  bev- 
erage. Sulphur  and  molasses  make  a  good  spring 
tonic  and  blood  purifier. 

In  cases  of  bumblebee  or  wasp  stings,  a  haudful  of 
mud  bound  on  the  w^ound  and  kept  moist  is  very 
effective. 

Mosquitoes  are  a  great  source  of  worry  in  the 
country;  bathing  the  bites  in  a  strong  salt  solution 
is  very  good. 


/T- 


INDEX 


Accidental  poisoning,  What 
to  do  in,  186 

Adenoids,  108 

Airing,  33 

Albumen  water,  78 

Antidotes  for  poisons,  187-191 

Arrowroot  gruel,  79 

Artificial  feeding  (substi- 
tute for  breast  milk),  47 

Baby   basket  and   contents,  3 

Baby  tender,  33 

Barley  flour  (where  obtained; 

kind),  63 
Barley  gruel    (percentages  of 

ingredients),  63 
Barley  jelly,  77 
Barley   water,    77 
Bath,*  15 

basin  or  sponge  for  fever,  16 

bran,  17 

salt,  17.     (For  malnourished 
children),  83 

in  hot  weather,  16 

mustard,   16 

soda,  17 

starch,    17 

tepid  bath,  16 

tub  for   fever,   16 

tub   (rubber)    for  traveling, 
18 
Bathing,    15 
Bed  wetting    (incontinence  of 

urine),   145 
Beef  broth,   77 
Beef  juice,  77 
Bites  of  animals,   136 
Bites  of  insects,   135 


Boils,   130 

Bottle    and    nipple,    Care    of, 

53-54 
Bowels  and  bladder  (training 

to  proper  control),  143 
Breast  and  nipples,   Care   of, 

37 
Breck   feeder,   81 
Bronchitis,    118 
Bruises,   139 
Burns,  132 

Cane-sugar,     50 ;     tablespoon- 

fuls  to  the  ounce,  58 
Canker  sore,   85 
Care  of  the  new-born  babe,  13 
Cereo  Company,  63 
Chapped  hands  or  lips,  134 
Chicken  broth,   77 
Chicken-pox,    167 
Chilblains,   134 
Children's  parties,   146 
Chorea  or  Saint  Vitus'  dance, 

175 
Circumcision,    143 
Clothing,  19 

for  the  expected  baby,  4 
Cold  in  the  head,  102 
"  Cold  sore  "  or  "  fever  sore," 

85 
Colic,  86 
Compress    (way   to    apply    to 

the  throat),  108 
Constipation,  92 
Contagious    diseases,     156    to 

172 
Convulsions,    14? 
Cough,    115 


203 


204 


INDEX 


Cracked  nipples,  38 
Cream    (gravity),  49 
Croup,  116 

catarrhal,   116 

diphtheritic,   117 
Croup  kettle,  116 
Cry   (the),  35 
Cuts,   140 

Dangers   in  the   country,   198 
Deming  percentage  milk  modi- 
fier, 64 
Dentition,  22 

Development    (of   the   normal 
child     at     different     pe- 
riods), 25 
Dextrinized   barley  water,   78 
Diarrhoea    (summer),   90 
Diet,  of  a  nursing  mother,  43 
Diet,  from  the  1st  to  the  6th 
year,   73 
from  the  12th  month  to  the 

18th    month,    73 
from  the  18th  month  to  the 

2d   year,    74 
from    the    2d    year    to    the 

6th  year,   75 
during    illness,    71 
Differences    in    the    sexes,    or 
what   every   child   should 
know,    193 
Diphtheria     (tonsilar,    nasal, 
laryngeal),   158 
(Disinfection  of  discharges, 
fumigation   after),   160 
Disinfection     for     contagious 

diseases,  180 
Disorders  of  sleep,  148 

Earache,   112;    relief  of,   113 
Ear-syringe  (soft  rubber),  113 
Eczema,  127 ;  method  of  band- 
aging in,  128 
Eczema    (intertrigo),  125 
Egg  water,  78 
Enlarged  tonsils,   111 


Enlargement  of  the  glands  of 
the  neck  ( acute,  chronic ) , 
120-121 

Excitement,  147 

Exercise,  31 

Exercise  pen,  32 

Eyes,  care  of,  21 

Feeding, 

artificial,  48 
bottle,  48 
Finger    and    thumb    sucking, 

150 
Fissure  of  the  anus,  96 
Flies,   danger  from,   183 
Food  preparation,  56-57-61 
Foreign  bodies  in  the  ear  or 

nose,  141 
swallowed,   142 
Formulae    for    bottle    feeding 

(see  Milk   formulae),   58- 

62 
Frost-bite,    133 
Fumigation    (see  Disinfection 

for   contagious   diseases), 

180 

Gain  in  weight,  25 

Genital  organs,  care  of,  143 

German   measles,    166 

Gertrude  outfit,  5 

Glands,  lymphatic,   120 
acute  enlargement  of,    120 
chronic      enlargement      of, 
121 

Grippe    (influenza),    156 

Growth,  24 

Hair,    122 

Hand-I-Hold  babe  mitts,    128 

Headaches,  114 

Head-lice,   123 

Healthy   baby,   the,   24 

Height    (of   the    well    child), 

29 
Hiccough,  95 


INDEX 


205 


Hives,  126 

Home   remedies,    199-200-201 

How   to   hold  the   baby   when 

nursing  the  bottle,  66 
How   to  hold   the  baby  when 

nursing  the  breast,  67 
How   to  examine   the   throat, 

105 
How   to    lift   the    infant   and 

young  child,  24 

Ice  box   (for  traveling),  72 
In-a-Wink  heater,   65 
Infantile  scurvy,  98 
Influenza    (see  Grippe),   156 
Intertrigo     (eczema     between 

surfaces   or   folds   of   the 

skin),  125 
Ivy  poisoning,  131 

Jersey  milk,  56 

Kissing,  37 

Knitted  bag  for  bottle,  65 

Knitted   abdominal    band,    5 

"  Legume  Flour,"  74 

Lime  water,  79 

Lisping,   155 

List  of  things  to  take  when 
going  away  for  the  sum- 
mer, 192 

Lumps  in  the  maternal  breast, 
39 

Malaria,  179 
Malnutrition,  82 
Maltose,  50 
Marasmus,  82 
Masturbation,    152 
Maternal  nursing,  39 

length    of    time    it    can    be 
done   to  advantage,   46 

with    supplementary    bottle 
feeding,   44 

contra-indications,   41 


Measles,   164 

Medicines  ( patent  medicines ) , 

185 

Mental     influence     over     the 

young  receptive  mind,  194 

Milk,  first  appearance  in  the 

breasts,   42 

normal        appearance        of 

breast  milk,  43 
improvement       of       breast 

milk,  43 
changes     in     breast     milk 
from  mental  impressions, 
44 
in  infants'  breasts,  23 
percentage     ingredients     of 

mother's  and  cow's,  48 
condensed,  69;   formulae,  70 
for  traveling,   72 
peptonized,  68 
formulae    (from   top   milk), 
58;   from  whole  milk,  62 
selection  of,  55 
care   of,   55-56 
modification,    55 
Milk-crust      ( seborrhoeic      ec- 
zema of  scalp),  123 
Milk  sugar  (tablespoonfuls  to 

the  ounce),  58 
Mixed  feeding,  44  g 

Mosquitoes     ( dangers    from ) , 

183 
Mouth   (care  of),  21 
Mumps,  168 
Mutton  broth,  77 

Nail  biting,    151 
Nettle-rash,   132 
Night  terrors,  148 
Normal  throat,  106 
Nosebleed,   140 
Nursery-maid,   10 
Nursery,   the,   7 

temperature  of,  7 
Nursing  bottle  and  nipple,  53 


206 


INDEX 


Nursing  bottle  and  nipple, 
method  of  cleansing,  53- 
54 

Nursing  for  twenty-four 
hours,  44 

Oatmeal  gruel  ( percentages 
of  ingredients),  63 

Oatmeal   jelly,    78 

Oatmeal  water,  77 

Oil    nebulizer,    104 

Otitis  media  (see  Earache), 
112 

Pacifier,  the,   152 

Painful    urination,    144-145 

Pasteurization   of   milk,    51 

Peptonized  milk,  68 

Pneumonia,   119 

Poisoning,  accidental.  What 
to  do  in  case  of,   186-191 

Premature  and  weak  infants, 
81 

Prickly  heat,  124 

Problems  of  the  village,  sub- 
urban, and  country 
mother,  and  ways  to 
meet  them,   195 

Proprietary  foods,   71 

Quarantine  ( see  Disinfection 
for  contagious  diseases ) , 
180 

Quarantine  room  for  con- 
tagious   diseases,    179 

Recipes,  77 

Retention  of  urine,   144 

Rheumatism,    173 

Rice-water,    78 

Rickets,  100 

Robinson's        patent       barley 

flour,  63 
Rules  for  feeding  children,  79 
Rush  of  milk  to  the  breasts, 

30 


Saint  Vitus'  dance,  175 
Scales  for  weighing,   28 
Scarlet  fever,  160 
Scraped  beef,   77 
Scurvy,    (infantile),  98 
Seborrhoeic    eczema      of      the 

scalp      ( see     Milk-crust ) , 

123 
Signs     of     successful     breast 

feeding,   68 
Signs    of   successful    artificial 

feeding,    67 
Skin    (care  of),    124 

(appearance  of,  in  health), 

25 

Sleep,   28 

in   health,    25 

excessive,    31 
Sore    mouth    (stomatitis),    85 
Special    senses     ( development 

of),  25 
Sprains,    138 
Sprue    (see  Thrush),  21 
Sterilization   (of  milk),  51 
Sties,    130 

Stings  and  bites,  135 
Stomatitis    (sore   mouth),   85 
Stools    (number  and  color   in 

health),   25 
Stuttering,   stammering,    155 
Substitute    for    breast    milk, 
artificial  feeding,  47 

Taking  cold,   101 
Talking    (normal),   26 

delayed,    155 
Teeth,   22 

appearance   of,   22 

care  of,  22 

(delayed  teething),  23 
Temperature       (use      of      the 

thermometer),    36 
Thrush     (care    of    the    teeth 

and  mouth),  21 
Tonsilitis,  107 
Toothache,    139 


INDEX 


207 


Toys,  11 

Training  to  proper  control  of 

bowels  and  bladder,  143 
Trained   nurse,    12 
Tuberculosis,   172 

Vaccination,    156 
Vomiting,    88 
habitual,    89 

Warts,   129 
Weaning,  46 


Weight  of  the  well  child,  29 

Wet-nurse,   the,  45 

What     every      child      should 

know    (difference    in   the 

sexes),  193 
Wheat  jelly,  78 
Wlien    should    the    doctor    be 

sent  for?,    184 
WTiere  to  spend  the  summer, 

191 
Whey,   79 

Whooping-cough,    169 
Worms,  97 


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5  individual  or  family."— iV.  V.  Times  Review. 


THE  EVOLUTION  OF  ANIMAL  INTELLIGENCE 

By  S.  J.  Holmes,  Professor  in  the  University  of  Wisconsin, 
With  illustrations  and.  charts.  8vo.  $2.75  net. 
A  general  account  of  the  evolution  of  animal  behavior  from 
the  mollusk  and  crustacean  up  to  apes  and  monkeys.  The 
critical  point  of  the  transition  from  instinct  to  intelligence  re- 
ceives special  treatment.  One  of  America's  leading  scientific 
authors  who  saw  the  manuscript  before  publication  writes, 
"  Holmes's  is  the  best  of  the  lot,  and  on  the  whole  the  most 
interesting  because  it  gives  the  most  facts;  i.e.,  examples, 
illustrations,  incidents,  stories,  etc.  Holmes  is  immensely  well 
informed." 

PFUNGST'S  CLEVER  HANS 

By  OsKAR  Pfungst.    Translated  by  Carl  L.  Rahn,  Fellow  in 
Psychology  in  the  University  of  Chicago.     i2mo.    $1.50. 
The  performances  of  Clever  Hans,  the  horse  of  Mr.  von 
Osten,  created  throughout  Germany  intense  excitement  and  a 
widespread,  overheated  discussion  of  animal  reason. 

"The  book  is  a  minute  and  careful  examination  of  the  facts  in  the 
case,  and  should  be  of  interest  to  psychologists  and  to  all  students  of 
the  mtelligence  of  the  lower  axixmoX^r— Springfield  Republican. 


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BOOKS   OF    PLAYS    FOR    YOUNG    FOLK 

DESIGNED   FOR   USE   IN   THE   SCHOOLS 

By    CONSTANCE    D'ARCY   MACKAY 

PATRIOTIC    PLAYS   AND    PAGEANTS 

Pageant  of  Patriotism  (Outdoor): -Prologue  bv  the  SDirit 
of  Patriotism,  ^Princess  Pocahontas,  Pilgnm  Interlude,  Fe^  Farm 
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'I    ^f  "''^/'■^"''';"    ^P^^"^^'     Abraham     Lincoln    Episode,    Final 
lableau,  Marcli  of  Players. 

Pageant  of  Patriotism  (Indoor)  a  variation  of  the  above. 

Havvthorne  Pageant  (for  Outdoor  or  Indoor  Production)-- 
Chorus  of  Spirits  of  the  Old  Manse,  Prologue  by  the  Muse  of  Haw- 
Se^HF  ,  ^lir^^  ^^'^  Witchcraft  Days),  Dance  Interlude, 
:5econd  lipisode  ^Merrymount),  Procession  of  Player  Folk. 

The  portions  of  the  pageants  marked  with  a  star  (*)  are  sepa- 
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THE    HOUSE    OF   THE    HEART 

Short  plays  in  verse  to  be  acted  by  children  of  fourteen  or 
younger.     $1.10  net.  by  mail,  $1.15. 

Includes:— "The  House  of  the  Heart"  (Morality  Play)  — 
"The  Enchanted  Garden"  (Flower  Play — "A  Little  Pilgrim's 
Progress"  (Morality  Play.  — "A  Pageant  of  Hours"  (To  be  given 
Out  of  Doors)— -On  Christmas  Eve."  "The  Elf  Child."  "The 
Princess  and  the  Pixies."  "The  Christmas  Guest."  (Miracle 
Play.)     Etc. 

*'An  addition  to  child  drama  which  has  been  sorely  needed." — Boston 
Transcript, 

THE    SILVER   THREAD 

And  Other  Folk  Plays.     $1.10  net  ;  by  mail,  $1.20. 

Contents  :—" The  Silver  Thread"  (Cornish);  "The  Forest 
Spring"  (Italian):  "The  Foam  Maiden  "  (Celtic);  "Troll  Magic" 
(Norwegian);  "The  Three  Wishes"  (French);  "A  Brewing  of 
Brains"  (English);  "Siegfried"  (German);  "The  Snow  Witch" 
(Russian). 

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LIFE. STORIES    FOR    THE    YOUNG 

Dean  Hodges'  SAINTS  AND  HEROES:    To  the  End  of  the 
Middle  Ages. 

Illustrated.    $1.35  net. 

Biographies  of  Cyprian,  Athanasius,  Ambrose,  Chrysostom, 
Jerome,  Augustine,  Benedict,  Gregory  the  Great,  Columba, 
Charlemagne,  Hildebrand,  Anselm,  Bernard,  Becket,  Langton, 
Dominic,  Francis,  Wycliffe,  Hus,  Savonarola. 

Each  of  these  men  was  a  great  person  in  his  time,  and  rep- 
resented its  best  qualities.  Their  dramatic  and  adventurous 
experiences  make  the  story  of  their  lives  interesting  as  well 
as  inspiring  and  suggestive. 

Church  history  and  doctrine  are  touched  upon  only  as  the}) 
develop  in  the  biographies. 

"Here  is  much  important  history  told  in  a  readable  and  attractive 
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most  likely  to  remain  fixed  in  memory,  namely,  the  standpoint  of  the 
individual    actor." — Springfield    Republican. 

Dean  Hodges'  SAINTS  AND  HEROES :  Since  the  Middle  Ages 

Illustrated.    $1.35  net. 

The  new  volume  includes  biographies  of  Luther,  More, 
Loyola,  Cranmer,  Calvin,  Knox,  Coligny,  William  the  Silent, 
Laud,  Cromwell,  Fox,  Wesley,  Bunyan  and  Brewster. 

John  Buchan's  SIR  WALTER  RALEIGH 

With  double-page  pictures  in  color;  cover  linings.    Square 
i2mo.     Price,  $2.00   net. 

A  life  of  Raleigh  told  in  eleven  chapters.  Each  chapter 
covers  some  important  scene  in  his  life  and  is  told  by  some 
friend  or  follower  as  if  seen  with  his  own  eyes.  Some  of 
the  characters  are  invented,  but  all  that  they  tell  really  hap- 
pened. 

The  narrative  has  spirit,  color,  and  atmosphere,  and  is 
unusually  well  written. 

America  figures  largely  in  the  story,  and  American  boys  will 
enjoy  this  book. 


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THE  HOME  BOOK  OF  VERSE 

American  and  English  (1580-1912) 
Compiled  by  Burton  E.  Stevenson.  Collects  the  best  short 
poetry  of  the  English  language — not  only  the  poetry  every- 
body says  is  good,  but  also  the  verses  that  everybody 
reads.  (3742  pages;  India  paper,  i  vol.,  8vo,  complete  au- 
thor, title  and  first  line  indices,  $7.50  net ;  carriage  40  cents 
extra.) 

The  most  comprehensive  and  representative  collection  of 
American  and  English  poetry  ever  published,  including 
3,120  unabridged  poems  from  some  1,100  authors. 

It  brings  together  in  one  volume  the  best  short  poetry 
of  the  English  language  from  the  time  of  Spencer,  with 
especial  attention  to  American  verse. 

The  copyright  deadline  has  been  passed,  and  some  three 
hundred  recent  authors  are  included,  very  few  of  whom 
appear  in  any  other  general  anthology,  such  as  Lionel 
Johnson,  Noyes,  Housman,  Mrs.  Meynell,  Yeats,  Dobson, 
Lang,  Watson,  Wilde,  Francis  Thompson,  Gilder,  Le 
Gallienne,  Van  Dyke,  Woodberry,  Riley,  etc.,  etc. 

The  poems  as  arranged  by  subject,  and  the  classifica- 
tion is  unusually  close  and  searching.  Some  of  the  most 
comprehensive  sections  are:  Children's  rhymes  (300 
pages) ;  love  poems  (800  pages) ;  nature  poetry  (400 
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(400  pages).  No  other  collection  contains  so  many  popu- 
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DELIGHTFUL  POCKET  ANTHOLOGIES 

The  following  books  are  uniform,  with  full  gilt  flexible  covers  and 
pictured  cover  linings.      i6mo.     Each,  cloth,  $1.50;  leather,  $2.50. 


THE  GARLAND  OF  CHILDHOOD 

A  little  book  for  all  lovers  of 
children.  Compiled  by  Percy- 
Withers. 

THE  VISTA  OF  ENGUSH  VERSE 

Compiled  by  Henry  S.  Pan- 
coast,  From  Spencer  to  Kip- 
ling. 

LETTERS  THAT  UVK 

Compiled  by  Laura  E.  Lock- 
wood  and  Amy  R.  Kelly.  Some 
150  letters. 

POEMS  FOR  TRAVELLERS 

(About    "The    Continent.") 
Compiled  by  Miss  Mary  R.  J. 
DuBois. 


THE  OPEN  ROAD 

A  little  book  for  wayfarers. 
Compiled  by  E.  V.  Lucas. 

THE  FRIENDLY  TOWN 

A  little  book  for  the  urbane, 
compiled  by  E,   V.  Lucas. 

THE  POETIC  OLD-WORLD 

Compiled  by  Miss  L.  H. 
Humphrey.  Covers  Europe,  in- 
cluding Spain,  Belgium  and  th« 
British   Isles. 

THE  POETIC  NEW- WORLD 

Compiled  by  Miss  Humphrey. 


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NEW  BOOKS  ON  THE  LIVING  ISSUES  BY  LIVING 
MEN   AND   WOMEN 

The  Home  University  Library 

Cloth  Bound  50c  per  volume  net ;  by  mail  56c. 

Points  about   THE  HOME   UNIVERSITY  LIBRARY 

Every  volume  is  absolutely  new,  and  specially  written  for 
the  Library.     There  are  no  reprints. 

Every  volume  is  sold  separately.  Each  has  illustrations 
where  needed,  and  contains  a  Bibliography  as  an  aid  to 
further  study. 

Every  volume  is  written  by  a  recognized  authority  on  its 
subject,  and  the  Library  is  published  under  the  direction  of 
four  eminent  Anglo-Saxon  scholars  —  Gilbert  Murray,  of 
Oxford;  H.  A.  L.  Fisher,  of  Oxford;  J.  Arthur  Thomson, 
of  Aberdeen;  and  Prof.  W.  T.  Brewster,  of  Columbia. 

Every  subject  is  of  living  and  permanent  interest.  These 
books  tell  whatever  is  most  important  and  interesting  about 
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Each  volume  is  complete  and  independent;  but  the  series 
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hensive library  of  modern  knowledge  covering  the  chief  sub- 
j'ects  in  History  and  Geography,  Literature  and  Art,  Science, 
Social  Science,  Philosophy,  and  Religion.  An  order  for  any 
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SOME  COMMENTS  ON  THE  SERIES  AS  A   WHOLE: 

"Excellent."— T/i^   Outlook.      "Exceedingly  worth   while." — The  Nation. 

"The   excellence   of   these   books." — The   Dial. 

"So    large    a    proportion    with    marked    individuality." — New    York    Sun. 

VOLUMES  ON  NATURAL  SCIENCE  NOW  READY 

The  Making  of  the  Earth  The  Origin  and  Nature  of  Life 

By  J.  W.  Gregory.  By  Benjamin  Moore. 

Man :  A  History  of  the  Human  Evolution 

Body— By  Arthur  Keith.  By  J.  A.  Thomson  and  P. 

Electricity — By  GiSBERT  KapP  Geddes. 

The  Principles  of  Physiology  Introduction  to  Mathematics 

By  J.  G.  M'Kendrick.  By  A.  N.  Whitehead. 

Matter  and  Energy  Evolution  of  Plants 

By  F.  SoDDY.  By  D.  H.  Scott. 

Psychology,  the  Study  of  Be-  Astronomy— By  A.  R.  HiNKS. 

kavior  Physical  Research 

By  W.  M.  M'DouGALL.  By  W.  F.  Barrett. 

Introduction  to  Science  The  Animal  World 

By  J.  A.  Thomson.  By  F.  W.  Gamble. 

Crime  and  Insanity  Anthropology 

By  C.  A.  Mercier.  By  R.  R.  Marett. 

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